Combining open and endovascular approaches to complex aneurysms.
Patients with aortic aneurysms commonly present with anatomic issues that preclude them from receiving purely endovascular repairs. In these situations, open surgical procedures can be used to manage anatomic problems and facilitate endovascular aneurysm repair. This report focuses on combined approaches that enable repair of abdominal or thoracoabdominal aortic aneurysms that involve the mesenteric and/or renal circulation. Current experience with combined open/endovascular repairs is essentially anecdotal. The common feature among the open procedures is establishment of extra-anatomic perfusion of the visceral arteries to enable ligation and subsequent coverage of their ostia during endograft placement. The existing reports are notable for the marked variability in many factors including extent of aneurysm repair, surgical approach, mode of visceral revascularization, conduit for bypass, and type of endovascular device used. Overall, current reports demonstrate that patients with limited physiologic reserve and complex aortic anatomy can be treated successfully by combining open and endovascular repairs. As endograft design and endovascular techniques continue to improve, combined approaches are likely to play an increasingly important role in the treatment of extensive aortic disease.
Lemaire
Scott A
SA
The Texas Heart Institute at St. Luke's Episcopal Hospital and The Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA. slemaire@bcm.tmc.edu
D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000473:pathology* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008833:Microcirculation / Q000473:pathology*; D008875:Middle Aged; D015996:Survival Rate