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A second unique advantage of the hybrid operating environment is in providing less-invasive therapeutic options. As in our patient, surgical graft revision would have required a second period of cardiopulmonary bypass and aortic clamping, and this was avoided by electing to perform a less-invasive percutaneous intervention. This resulted in a dramatic improvement in the graft flow and distal runoff with recruitment of collaterals and immediate resolution of the patient's mitral regurgitation. Moreover, the hybrid environment will undoubtedly lead to more liberal use of minimally invasive valve operations combined with percutaneous coronary interventions and combined surgical and percutaneous revascularization techniques. 3 References 1. Byrne JG, Leacche M, Unic D, Rawn JD, Simon DI, Rogers CD, et al.Staged initial percutaneous coronary intervention followed by valve surgery ("hybrid approach") for patients with complex coronary and valve disease.

Aortouniiliac stent grafts allow the endovascular treatment of complex anatomy aortoiliac aneurysms. The main drawback is the need for femoro-femoral crossover bypass, with its complications and its patency limitations. However, some authors have shown good results of femoro-femoral crossover bypass in aneurysmal disease. In this article, initial and long-term results of our experience in femoro-femoral crossover bypass revascularization after endovascular aortouniiliac stent grafts repair of aortoiliac aneurysms is reported. Prospective collection, intention-to-treat, and retrospective analysis maintained database. Femoro-femoral crossover bypass patency assessment of all patients treated between January 1999 and September 2002, compared patients with or without associated occlusive arterial disease. Urgent indications were excluded. In total of 52 patients, with a mean age 72.6 years, 30.8% of patients were identified with associated occlusive arterial disease. Initial systemic and local, access site, complications were 7.7% and 7.7%, respectively, no early thrombosis or death is reported. Primary patency was 90.9% at 54 months, 66 months assisted primary and secondary patency were 97.7% and 100%, respectively. The 48-month survival rate was 84.2%. No significant differences between patients with or without associated occlusive arterial disease were found. Femoro-femoral crossover bypass after aortouniiliac stent grafts treatment of aortoiliac aneurysms shows excellent initial and long-term patency and low complication rate.

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