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Open and endovascular aortic surgery in complex situations - competition or complementation?

In the last decades we have been witnessing more and more surgical aortic reconstruc tions being replaced with endovascular procedures, with good preliminary Results, but sometimes with equal or worse long-term outcome. While endovascular stent-grafts cannot be used for in-situ reconstruction in the infected aortic tissue, the usage of cryopreserved aortic homografts has recently seen resurgence for in-situ reconstruction of complex aortic infections Some problems can be treated with EVAR more successfully, while others are still being treated surgically, depending on available Materials and experience in the instituti on. However, there are situations when both approaches can be successfuly combined, and one method can also be used to treat complications of another approach. Hereby we describe two patients in whom both approaches were used in succession, In one patient, a complication after TEVAR was successfuly treated with open surgical repair, while in another patient EVAR was successfully used to treat aneurysmal dilatation of cryopreserved homograft. . A young male was treated with TEVAR for descending aortic false aneurysm. Later on he developed aortoesophageal fistula with massive bleeding that was successfully treated by open surgical reconstruction with cryopreserved homograft. WO .. Another male patient underwent complex aortic reconstruction with cryopreserved ho mograft for ruptured mycotic aneurysm, with visceral artery debranching. Aneurysmal di latation of homografi developed five years after the procedure, and was treated by EVAR. In our experience, both endovascular and surgical aortic reconstruction have been used successfully, tailored individually to each patient. Experience in treating complications af ter surgery with endovascular techniques and vice-versa, showed that both techniques have their place and merits in complex situations. Evaluating both short and long-term Results of combined and sequential surgical and endovascular procedures, as well as the long-term value of cryopreserved homografts, is essential in order to define optimal indications for these complementary Methods in complex aortic reconstructions.

open and endovascular aortic surgery

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