[jstimpfle]

Not really. It's not a workaround - it just works.

Maybe most uses of lexical macros could be done with hygienic macros / macro replacement bodies that are fully formed expressions (AST nodes), but not all of them.

For those macros, really the "hygienic" doesn't matter half as much as people pretend. Don't do complex macros where the "hygienic" is required. Don't generate code, write code. If you need to generate syntax to remove boilerplate, then sprinkle a few macros in. But to generate syntax, in general you'll need a lexical macro system.