Thoracic aortic stents: A combined solution for complex cases

Objectives: the combination of endovascular and standard surgical techniques may facilitate the management of complex
aortic disease although the long-term durability of this approach needs to be confirmed.
Design: a retrospective review of our experience in the treatment of patients with complex aortic pathology using a
combined endovascular and surgical approach.
Materials and methods: between 1998 and 2001, 27 patients with thoracic aortic aneurysm underwent stent-graft
implantation. Eight required combined endovascular and surgical procedure because of complex pathology. In 3 cases,
combined repair was carried out for a concomitant abdominal aortic aneurysm or aorto-iliac-femoral occlusive disease. In
the other 5 cases, vessel relocation was performed to obtain safe landing zones: left subclavian artery to left carotid artery
translocation in 3 patients, celiac trunk to superior mesenteric artery translocation in one and aorto-celiac-mesenteric
bypass grafting in one.
Results: one of the 8 patients died on 12th post-operative day of intestinal bleeding and bowel infarction. No neurological
sequelae were reported. The other patients are currently well at 11 months mean follow-up time.
Conclusions: simultaneous surgical and endovascular procedure is a feasible and may be a valuable adjunct to the
treatment of complex aortic and peripheral vessel anatomy.