title: Hybrid Treatment of an Abdominal Aortic Aneurysm with Severe Calcification of the Neck and Aortic Bifurcation.
abstract: BACKGROUND
  Severe calcification of the aorta or iliac vessels remains a major concern when planning open or endovascular treatment of an abdominal aortic aneurysm (AAA). Therefore, we present a unique case of an AAA with concomitant severe calcification of the entire infrarenal aortoiliac region and discuss on proper management.
  
  
  METHODS
  A 70-year-old patient with a symptomatic AAA was scheduled for repair. The diagnostic investigation revealed a 70-mm-diameter AAA with severe calcification of the neck and the iliac and femoral arteries, raising major concerns regarding the proper repair strategy. Under careful consideration of all the risks and parameters, the patient underwent a hybrid treatment with endovascular balloon occlusion of the aortic neck and careful clamping just proximal to the bifurcation. Minimal mobilization of the aorta, careful transecting and drilling of the aortic wall, and careful suturing of a straight graft were part of the whole strategy. One-year follow-up of the patient is unremarkable.
  
  
  CONCLUSIONS
  In cases of AAA with significantly calcified aorta and aortic bifurcation, careful preoperative planning is imperative, taking into consideration the individualized characteristics of each patient. Hybrid techniques including proximal endovascular occlusion, careful mobilizations, aortic wall drilling, and tight suturing of the graft could be a reasonable strategy for such patients. However, larger case series is needed to prove the efficacy of this method.
authors.affiliation: Division of Vascular Surgery, First Propaedeutic Department of Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece. Electronic address: georgegalyfos@hotmail.com.
authors.forename: George
authors.initials: G
authors.lastname: Galyfos
authors.affiliation: Division of Vascular Surgery, First Propaedeutic Department of Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors.forename: Fragiska
authors.initials: F
authors.lastname: Sigala
authors.affiliation: Division of Vascular Surgery, First Propaedeutic Department of Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Basigos
authors.affiliation: Division of Vascular Surgery, First Propaedeutic Department of Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Karantzikos
authors.affiliation: Division of Vascular Surgery, First Propaedeutic Department of Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors.forename: Stilianos
authors.initials: S
authors.lastname: Katsaragakis
authors.affiliation: Division of Vascular Surgery, First Propaedeutic Department of Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Filis
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D021721:Balloon Occlusion; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D003131:Combined Modality Therapy; D000072226:Computed Tomography Angiography; D003250:Constriction; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000150:complications* / Q000000981:diagnostic imaging