title: Hybrid Treatment of Large Brachial Artery Pseudoaneurysms.
abstract: BACKGROUND
  Conventional surgical treatment of brachial artery pseudoaneurysms (BAPs) includes aneurysm excision/opening and subsequent arterial reconstruction with different options depending on the extent of the arterial deficit. Endovascular repair of BAPs with stent grafting has also been reported but published experience remains limited. In this report, we present our experience with a novel hybrid approach consisting of primary endovascular aneurysm exclusion with a stent graft and subsequent open surgical evacuation of pseudoaneurysm content for decompression of adjacent structures.
  
  
  METHODS
  This study included all patients who underwent hybrid repair of a BAP within the period 2005-2014 in our institution. Data were collected retrospectively.
  
  
  RESULTS
  During the study period a total of 5 patients with iatrogenic BAPs were treated. Mean BAP diameter was 58 ± 4.9 mm. Technical success was 100%. Thirty-day mortality was null. No major perioperative complications were noted. Hand ischemia and neurological symptoms were reversed in all patients after the procedure. During follow-up (median 24 months, range 6-60 months) all stent grafts remained patent and no aneurysm relapse was noticed. No signs of stent-graft infection were noticed in any of the patients and no reintervention was needed.
  
  
  CONCLUSIONS
  Primary endovascular exclusion of BAPs with a stent graft followed by surgical evacuation of pseudoaneurysm sac content is associated with good early and mid-term results in this limited experience. Larger patient cohorts are required for further evaluation of this technique.
authors.affiliation: 1st Department of Surgery, Vascular Division, Athens University Medical School, Laiko Hospital, Athens, Greece.
authors.forename: Chris
authors.initials: C
authors.lastname: Klonaris
authors.affiliation: 1st Department of Surgery, Vascular Division, Athens University Medical School, Laiko Hospital, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Patelis
authors.affiliation: 1st Department of Surgery, Vascular Division, Athens University Medical School, Laiko Hospital, Athens, Greece.
authors.forename: Mikes
authors.initials: M
authors.lastname: Doulaptsis
authors.affiliation: Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany. Electronic address: akatsargyris@gmail.com.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Katsargyris
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000601:surgery*; D015901:Angiography, Digital Subtraction; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D006115:Greece; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome