Hybrid Treatment of an Abdominal Aortic Aneurysm with Severe Calcification Of The Neck and Aortic Bifurcation

• Published in: Annals of vascular surgery Vol. 36; pp. 294.e7 - 294.e11
• Main Authors: Galyfos, George, MD, PhD, Sigala, Fragiska, MD, PhD, Basigos, Gerasimos, MD, PhD, Karantzikos, Georgios, MD, PhD, Katsaragakis, Stilianos, MD, PhD, Filis, Konstantinos, MD, PhD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.10.2016
• Subjects: Aged; Aortic Aneurysm, Abdominal - complications; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - surgery; Aortography - methods; Balloon Occlusion; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - instrumentation; Combined Modality Therapy; Computed Tomography Angiography; Constriction; Humans; Male; Severity of Illness Index; Surgery; Suture Techniques; Time Factors; Treatment Outcome; Vascular Calcification - complications; Vascular Calcification - diagnostic imaging; hybrid repair; abdominal aortic aneurysm; calcification
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2016.03.024

Abstract Introduction Severe calcification of the aorta or iliac vessels remains a major concern when planning open or endovascular treatment of an AAA. Therefore, we present a unique case of an AAA with concomitant severe calcification of the entire infrarenal aorto-iliac region and discuss on proper management. Case report A 70-year-old patient with a symptomatic abdominal aortic aneurysm (AAA) was scheduled for repair. The diagnostic investigation revealed a 70mm in diameter AAA with severe calcification of the neck as well as 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 proximally of the bifurcation. Minimal mobilization of the aorta, careful transecting and drilling of the aortic wall as well as 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 need to prove the efficacy of this method.