Endovascular repair of perisplanchnic abdominal aortic aneurysm with visceral vessel transposition.
OBJECTIVE
To report a combined endoluminal and open surgical approach for a suprarenal abdominal aortic aneurysm (AAA) with coexistent splanchnic vessel stenoses.


RESULTS
A 64-year-old man presented with an aneurysm of the proximal abdominal aorta and severe stenoses of the celiac axis and superior mesenteric artery (SMA). An initial 2-stage plan to stent the visceral vessel stenoses and exclude the aneurysm with a fenestrated stent-graft failed when the celiac lesion could not be crossed. The approach was changed to restore visceral perfusion with a bifurcated left iliosplenic and ilio-SMA bypass graft. Exclusion of the aneurysm was achieved with a custom-made suprarenal aortic tube stent-graft (Ivancev-Malmö) system. The patient is free of symptoms at 22 months, and there was no aneurysm visible on the 14-month CT scan.


CONCLUSIONS
Hybrid techniques are an alternative treatment for complex perivisceral aortic aneurysms when total endovascular reconstruction is not possible.
Macierewicz
J A
JA
Department of Vascular and Endovascular Surgery, Queen's Medical Centre, Nottingham, England, UK. jasionek@aol.com
Jameel
M M
MM
Whitaker
S C
SC
Ludman
C N
CN
Davidson
I R
IR
Hopkinson
B R
BR
D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008638:Mesenteric Arteries; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D015607:Stents; D014781:Viscera / Q000098:blood supply