title: Hybrid treatment of multiple aortic aneurysms by combined conventional surgery and endovascular aortic repair.
abstract: OBJECTIVE
  We evaluated the operative results of our treatment for multiple aortic aneurysms by means of a hybrid procedure consisting of a combination of conventional surgical maneuvers and simultaneous or sequential endovascular aortic repair (EVAR).
  
  
  METHODS
  From August 1998 to April 2007, a total of 15 patients, 11 men and 4 women, ranging in age from 62 to 78 years, were treated with hybrid procedures for multiple aortic aneurysms. The pathology of these patients were, atherosclerotic aneurysm in 12 patients, atherosclerotic aneurysm associated with chronic dissection in 2 and type III chronic dissection in 1 patient. The distribution of aneurysmal locations were as follows: 5 patients had aneurysms at the arch and descending aorta, 1 had at the arch and thoracoabdominal aorta, 6 at the descending and abdominal aorta. Two patients with chronic dissection had simultaneous abdominal aortic aneurysms. In all except 1 of the 7 patients who had abdominal aortic aneurysm, we performed abdominal aneurysmectomy and EVAR simultaneously. In 7 patients, EVAR was performed sequentially after graft replacement surgery. In 2 patients, EVAR was the initial procedure followed by conventional surgery. The mean interval between first and second stage procedures was approximately 4 months.
  
  
  RESULTS
  One patients died of methicillin resistant Staphylococcus aureus pneumonia 3 months after the simultaneous procedure, all others were discharged and survive. In particular, no major EVAR linked complication was observed in the follow-up period (range 3 to 91 months, mean 46 months).
  
  
  CONCLUSIONS
  The hybrid procedure for the treatment of multiple aortic aneurysmal disease is less invasive compared to conventional staged surgery and the outcome in terms of mortality and morbidity in hospital as well as long-term follow-up are satisfactory.
authors.affiliation: Department of Vascular Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Obitsu
authors.forename: Nobusato
authors.initials: N
authors.lastname: Koizumi
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Iida
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Satou
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Hisahito
authors.initials: H
authors.lastname: Takae
authors.forename: Naozumi
authors.initials: N
authors.lastname: Saiki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kawaguchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shigematsu
keywords: elephant trunk; endovascular aortic repair; hybrid procedure; multiple aortic aneurysms
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