Sage Journals: Discover world-class research

Abstract

Purpose:

To report a combined endoluminal and open surgical approach for a suprarenal abdominal aortic aneurysm (AAA) with coexistent splanchnic vessel stenoses.

Methods and 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.

Keywords

endovascular grafting suprarenal aortic aneurysm vessel transposition Ivancev-Malmö system

Get full access to this article

View all access options for this article.

References

Walker

Yusuf

Wenham

. Renal complications following endovascular repair of abdominal aortic aneurysms. J Endovasc Surg. 1998;5:318–322.

Elmarasy

Soong

Walker

. Sigmoid ischemia and the inflammatory response following endovascular abdominal aortic aneurysm repair. J Endovasc Ther. 2000;7:21–30.

Thompson

Nasim

Sayers

. Oxygen free radical and cytokine generation during endovascular and conventional aneurysm repair. Eur J Vasc Endovasc Surg. 1996;12:70–75.

Donaldson

Belkin

. Mesenteric revascularization during aneurysmectomy. Surg Clin North Am. 1997;77:443–459.

Ivancev

Malina

Lindblad

. Abdominal aortic aneurysms: experience with the Ivancev-Malmöendovascular system for aortomonoiliac stent-grafts. J Endovasc Surg. 1997;4:242–251.

Reilly

Ramos

Murray

. Optimal exposure of the proximal abdominal aorta: a critical appraisal of transabdominal medial visceral rotation. J Vasc Surg. 1994;19:375–389.

Nypaver

Shepard

Reddy

. Supraceliac aortic cross-clamping: determinants of outcome in elective abdominal aortic reconstruction. J Vasc Surg. 1993;17:868–875.

Cohen

Sardari

Paul

. Increased intestinal permeability: implications for thoracoabdominal aneurysm repair. Ann Vasc Surg. 1992;6:433–437.

Kashyap

Cambria

Davison

. Renal failure after thoracoabdominal aortic surgery. J Vasc Surg. 1997;26:949–957.

10.

Brown

Hartley

Purchas

. A fenestrated covered suprarenal aortic stent. Eur J Vasc Endovasc Surg. 1999;18:445–449.

11.

Faruqi

Chuter

TAM

Reilly

. Endovascular repair of abdominal aortic aneurysm using a pararenal fenestrated stent-graft. J Endovasc Surg. 1999;6:354–358.

12.

Park

Chung

Choo

. Fenestrated stent-grafts for preserving visceral arterial branches in the treatment of abdominal aortic aneurysms: preliminary experience. J Vasc Interv Radiol. 1996;7:819–823.

13.

Inoue

Iwase

Sato

. Transluminal endovascular branched graft placement for a pseudoaneurysm: reconstruction of the descending thoracic aorta including the celiac axis. J Thorac Cardiovasc Surg. 1997;114:859–861.

14.

Quinones-Baldrich

Panetta

Vescera

. Repair of type IV throacoabdominal aneurysm with a combined endovascular and surgical approach. J Vasc Surg. 1999;30:555–560.

15.

Buth

Penn

Tielbeek

. Combined approach to stent-graft treatment of an aortic arch aneurysm. J Endovasc Surg. 1998;5:329–332.

16.

Dereume

Ferreira

Dehon

. Abdominal aortic aneurysms involving the ostia of the visceral arteries [abstract]. J Mal Vasc. 1998;23(suppl A):75–76.

Endovascular Repair of Perisplanchnic Abdominal Aortic Aneurysm with Visceral Vessel Transposition