Hybrid vascular surgery means combining an open operation and a catheter-based procedure in the same session, under one anaesthetic. It exists because arterial disease rarely confines itself to one level: a blockage in the pelvis and another in the thigh cannot always be solved by one technique, and treating only half of the problem leaves the leg no better off.
In short: hybrid treatment addresses disease at two levels in one sitting — for example opening the groin artery surgically while stenting the pelvic artery above it through the same incision. It is used mainly in complex, multilevel peripheral artery disease and in limb salvage, where neither approach alone would restore enough flow. Suitability is decided from imaging, not from preference.
The problem hybrid surgery solves
The chain of arteries, and its three segments
Blood reaches the foot through a chain of arteries. Vascular surgeons think about that chain in three segments: inflow (the aorta and pelvic arteries), the common femoral artery in the groin where the chain divides, and outflow (the thigh and the vessels below the knee). A leg in trouble frequently has disease at more than one of these levels, and that is where single-technique treatment runs out of road.
Why catheters struggle at the groin
Catheters are excellent in the pelvis, where vessels are large and straight. They are far less satisfactory at the common femoral artery, which bends, is heavily loaded with plaque, sits at a branch point and is crossed every time the hip flexes — a stent there is poorly suited to the mechanics. Open surgery handles that segment well but cannot reach far up into the pelvis without a much larger operation. Hybrid treatment takes the strength of each and uses it where it works.
The commonest combination
The classic hybrid procedure is an endarterectomy of the common femoral artery — opening the artery, removing the plaque from inside it and patching it closed — combined with stenting of the iliac artery above, performed through the very incision that has just been made. The exposed artery gives direct, controlled access for the wires and catheters, which is often easier and safer than approaching from a remote puncture.
The same logic runs downward: the groin is cleared surgically and the arteries below the knee are then treated with balloons through the same opening, restoring a continuous line of flow to the foot in one anaesthetic rather than two.
When it is the right choice
| Pattern of disease | Why a single technique falls short | What hybrid treatment does |
|---|---|---|
| Pelvic blockage plus groin plaque | A stent across the groin bend performs poorly; open repair alone leaves the inflow blocked | Endarterectomy at the groin, stent above through the same incision |
| Groin plaque plus blocked thigh and calf arteries | Opening the groin alone does not get blood to the foot | Endarterectomy plus balloon treatment of the vessels below in one sitting |
| Failed previous bypass or stent | Re-operating through scar tissue is difficult and carries more risk | A limited open exposure combined with catheter work through it |
| Threatened limb with tissue loss | Time and anaesthetic exposure both matter | One session restores flow at every level, so the wound can heal |
Where and how it is performed
It takes place in a theatre equipped both as a sterile operating room and with high-quality imaging, so that an open operation and live X-ray guided catheter work can proceed without moving the patient. Anaesthesia may be general, spinal or local with sedation, depending on what is planned and on the patient's condition.
- Imaging is reviewed and the plan agreed — which level is treated openly and which by catheter.
- The artery is exposed through a limited incision, usually in the groin.
- Plaque is removed from that segment and the artery is widened with a patch.
- Wires and catheters are passed through the opened artery to treat the level above or below, with balloons and stents as required.
- Flow is checked on imaging before closing, so that any residual narrowing is dealt with while access is still available.
Compared with the alternatives
| Catheter treatment alone | Open surgery alone | Hybrid | |
|---|---|---|---|
| Suits | Single-level disease in larger vessels | Disease at the groin, or where catheters cannot cross | Disease at two or more levels |
| Anaesthetic | Usually local | General or spinal | General, spinal, or local with sedation |
| Incision | Puncture only | Incision, sometimes extensive | One limited incision |
| Recovery | Fastest | Longest | Between the two, and shorter than two separate operations |
| Main limitation | Poor durability across the groin bend | Cannot reach distant segments without larger surgery | Needs an equipped theatre and a team used to both |
Risks and recovery
What recovery looks like
Recovery sits between the two parent techniques and is considerably shorter than undergoing them as two separate operations. Walking usually begins the day after, and hospital stay is typically a few days rather than the overnight stay of a purely catheter procedure.
The risks that matter
- Groin wound problems — the commonest issue after femoral endarterectomy: fluid collection, delayed healing or infection, more likely in diabetes and obesity.
- Bleeding or a swelling at the puncture or incision, occasionally needing repair.
- Contrast and the kidneys — the dye used for imaging is a consideration in reduced kidney function, and is planned for in advance.
- Stent or repair narrowing again over time, which is what surveillance scanning is designed to find early.
- General surgical risks relating to anaesthesia, chest and heart, assessed beforehand.
Seek emergency care if the treated leg becomes suddenly cold, pale, numb or severely painful — this can mean the repair or stent has blocked, and there is only a short window to reopen it. Also seek urgent review for bleeding, a rapidly enlarging swelling in the groin, a wound that opens or discharges, or fever with spreading redness. Report new pain on walking that returns after it had settled, as it can be the first sign of a narrowing re-forming.
Afterwards
Three things carry the result. Antiplatelet and statin medication is taken consistently, because it protects both the repair and the rest of the arterial tree. Walking is prescribed rather than merely permitted — a structured walking routine improves distance beyond what the procedure alone achieves. Surveillance scanning at intervals finds a narrowing while it is still treatable with a balloon rather than a repeat operation. And for anyone still smoking, stopping does more for the long-term patency of the repair than any other single measure.
In Istanbul
Prof. Dr. Yusuf Kalko plans and performs hybrid vascular procedures for complex and limb-threatening disease in Istanbul (Beylikdüzü). Contact us for an appointment. International patients are welcome.
Related Pages
Why Choose Turkey (Istanbul) for Your Treatment?
- Over 30 years of experience in cardiovascular and vascular surgery.
- Advanced minimally invasive and hybrid techniques.
- English- and Arabic-speaking support for international and Gulf patients.
- Easy access to Istanbul from the Gulf, Europe and beyond.
- Pre-travel remote assessment, then treatment and appointment planning.
How to Start from Abroad (Remote Consultation)
You can send your medical reports and scan images via WhatsApp for an initial assessment before traveling. We then plan your treatment and appointment in Istanbul, Turkey, and support international patients at every step.
📋 This page is part of our Vascular Diseases guide. See the overview for other vascular conditions, symptoms and treatments in Turkey (Istanbul).
Multi-level disease is one of the most common reasons a vessel is called “unopenable” — see second opinion and limb salvage.
Frequently Asked Questions
What is hybrid vascular surgery?
It is the combination of an open operation and a catheter-based procedure in the same session under one anaesthetic — for example clearing the groin artery surgically while stenting the pelvic artery above it through the same incision.
Why would a hybrid approach be chosen over one or the other?
Because arterial disease is often present at more than one level. Catheters work well in the large pelvic vessels but poorly across the groin, where the artery bends with every step; open surgery handles the groin well but cannot reach far up the pelvis without a much bigger operation. Hybrid treatment applies each technique to the segment it suits.
Is recovery harder than a purely catheter procedure?
It is somewhat longer, because there is an incision — usually a few days in hospital rather than going home the same day. It is considerably easier than having an open operation and a catheter procedure on two separate occasions, which is the realistic alternative.
Who is a candidate?
People with disease at two or more levels in the same leg, those with a heavily diseased common femoral artery, those whose previous bypass or stent has failed, and people with a threatened limb where flow has to be restored along the whole chain. The decision is made from imaging.
What are the main risks?
Groin wound problems are the most frequent, particularly in diabetes. Others include bleeding or swelling at the access site, the effect of contrast dye on reduced kidney function, re-narrowing over time, and the general risks of anaesthesia, all of which are assessed beforehand.
How long does the result last?
That depends on the pattern of disease, the segments treated and above all on what happens afterwards: taking the prescribed medication, walking regularly, controlling diabetes and cholesterol, and stopping smoking. Surveillance scans are arranged to find a re-narrowing early, while it can still be treated with a balloon.
Will I need more procedures later?
Possibly. Arterial disease is a continuing condition rather than a one-off repair, and further narrowing can develop at the treated site or elsewhere. Picking it up at a routine scan usually means a straightforward balloon treatment instead of repeat surgery.
Do you treat international patients?
Yes. International and Gulf patients are seen in Istanbul with English- and Arabic-speaking support, and an initial remote assessment can be made from your reports and scan images before you travel.