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Related Concept Videos

Aneurysm III: Interprofessional Care01:26

Aneurysm III: Interprofessional Care

Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
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Combining open and endovascular approaches to complex aneurysms.

Scott A Lemaire1

  • 1The 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

Annals of the New York Academy of Sciences
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PubMed
Summary

Complex aortic aneurysms often require combined open and endovascular surgical repairs. These hybrid approaches successfully treat patients with challenging anatomy and limited physiological reserve, improving outcomes for extensive aortic disease.

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Area of Science:

  • Vascular Surgery
  • Endovascular Interventions
  • Aortic Aneurysm Repair

Background:

  • Many patients with aortic aneurysms have complex anatomy unsuitable for purely endovascular repair.
  • Open surgical techniques can address these anatomical challenges, facilitating subsequent endovascular aneurysm repair.
  • Combined open/endovascular approaches are emerging for abdominal and thoracoabdominal aortic aneurysms involving visceral circulation.

Purpose of the Study:

  • To review current experience with combined open and endovascular repair strategies for complex aortic aneurysms.
  • To highlight the role of open procedures in managing visceral artery anatomy during endovascular aneurysm repair.
  • To assess the feasibility and outcomes of hybrid repairs in patients with extensive aortic disease.

Main Methods:

  • Focus on combined open/endovascular repair techniques for abdominal and thoracoabdominal aortic aneurysms.
  • Description of open procedures establishing extra-anatomic perfusion of visceral arteries.
  • Ligation and coverage of visceral artery origins during endograft placement.

Main Results:

  • Current experience with combined repairs is largely anecdotal, showing significant variability in approaches.
  • Successful treatment of patients with limited physiological reserve and complex aortic anatomy is demonstrated.
  • Combined strategies enable repair of aneurysms involving mesenteric and/or renal arteries.

Conclusions:

  • Combined open and endovascular repairs offer a viable solution for complex aortic aneurysms.
  • These hybrid techniques are effective in patients who are not candidates for standard endovascular repair.
  • Advancements in endograft technology and techniques will likely increase the role of combined approaches in treating extensive aortic disease.