Introduction: Peripheral arterial disease (PAD) represents a local manifestation of a lethal systemic 
disease atherosclerosis and portends a 2-6fold increase in both cardiovascular and cerebrovascular 
events. The diagnosis is also associated with an annual mortality rate of 4%-6%. (Malyar et al., 2016).
Aim of the work: 1- Evaluation of the feasibility and efficacy of the hybrid surgical and 
endovascular therapy in patients with complex multifocal steno-occlusive vascular disease. 2- Report 
short and midterm outcomes through assessment of patency and salvage rate. 3- Evaluate safety of 
hybrid procedure , and report complications and re-intervention if needed . Patients and Methods: A 
prospective study was carried out on twinty patients (20 limbs) presented with critical lower limb 
ischemia due to multi-level peripheral arterial disease involving CFA presented to the vascular and 
endovascular surgery unite , General surgery department , Minia university hospital. Results: The 
study included twenty patients (20 limbs) who were suffering from multilevel peripheral arterial 
disease with critical lower limb ischemia, who underwent hybrid procedures at vascular and 
endovascular surgery unit Minia University Hospital, Egypt. Summary: Our results show that CFA 
endarterectomy or bypass surgery in compination with inflow or outflow endovascular procedures 
can simplify the management of multilevel PAD in this group of high risk patients, as each lesion in 
different patho-anatomical configuration can be treated with an approach that will best optimize 
outcomes and ensure safety for the patients as a whole.