title: Endovascular repair of perisplanchnic abdominal aortic aneurysm with visceral vessel transposition.
abstract: 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.
authors.affiliation: Department of Vascular and Endovascular Surgery, Queen's Medical Centre, Nottingham, England, UK. jasionek@aol.com
authors.forename: J A
authors.initials: JA
authors.lastname: Macierewicz
authors.forename: M M
authors.initials: MM
authors.lastname: Jameel
authors.forename: S C
authors.initials: SC
authors.lastname: Whitaker
authors.forename: C N
authors.initials: CN
authors.lastname: Ludman
authors.forename: I R
authors.initials: IR
authors.lastname: Davidson
authors.forename: B R
authors.initials: BR
authors.lastname: Hopkinson
mesh_terms: 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