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The purpose of this article is to report whether combined open and endovascular treatment could be applied in patients with complex aortic disease. A retrospective study including four patients with complex aortic disease was undertaken. In all patients, extra-anatomic bypass to the visceral arteries was made through a laparotomy while the aortic lesion was repaired by stent grafting. One patient died on the first postoperative day and another died 3 months after treatment from a myocardial infarction. The other two patients were alive 13 and 34 months after treatment, respectively. However, a patient treated for a ruptured thoracoabdominal type 2 aneurysm on the basis of a dissection suffers from postoperative paraplegia. The combination of open surgery with extra-anatomic bypass to visceral arteries and stent grafting could be an option for the treatment of patients with complex aortic disease, especially in high-risk cases in which more extensive open surgery is contraindicated.

The goal of the present study was to investigate the number of operations for abdominal aortic aneurysm (AAA) including time-trends in treatment during a 20-year period. Operating time and anesthesia time were also studied. During the period 1983–2002, a total of 1,041 patients with AAA were treated with open surgery (905) or EVAR (136). Number of operations, type of graft, anesthesia time, and operating time were the variables investigated. Data were collected retrospectively from the patients’ medical records. There was an increase in the number of operations both for ruptured and non-ruptured AAA in men during the study period. Among women, an increase was observed only for ruptured aneurysm. Operating time and anesthesia time increased significantly during the 20-year period. The number of patients treated by EVAR increased significantly, beginning in 1995. In conclusion, there has been an increase in the number of AAA operations, and the proportion of patients treated with EVAR is increasing. Furthermore, we found an increase in both anesthesia time and operating time. These trends may be important for allocation of resources needed for the treatment of patients with AAA. [ABSTRACT FROM AUTHOR]