# Hybrid repair of the complex celiac artery aneurysm

## TL;DR

A complex celiac artery aneurysm was successfully repaired using a hybrid approach combining open surgery and endovascular techniques.

## Contribution

Demonstrates the effectiveness of hybrid repair in complex celiac artery aneurysms when endovascular methods fail.

## Key findings

- Hybrid repair successfully excluded the aneurysm and maintained patency of the hepatic and splenic arteries.
- Initial endovascular repair failed due to anatomical barriers, requiring a combined open and endovascular approach.
- Follow-up confirmed a stable outcome with no endoleaks and a patent-covered stent.

## Abstract

Celiac artery aneurysms (CAAs) are rare but potentially life-threatening vascular abnormalities with high mortality rates if left untreated. While open surgical repair has been the standard treatment, it carries significant risks, particularly in elderly or comorbid patients. Endovascular surgery offers a less invasive alternative; however, anatomical complexities can limit its effectiveness. Herein, we report the hybrid repair of a complex CAA case.

The patient was an 82-year-old male who had a celiac aneurysm that increased in size during follow-up and was accompanied by a pseudoaneurysm. The first endovascular repair through the right common femoral artery failed because of an anatomic barrier. A week later, a second endovascular repair was attempted using an open approach, followed by covered stent deployment and branch embolization through the common hepatic artery. Completion angiograms demonstrated no endoleaks, successful celiac branch embolization, and patent common hepatic and splenic arteries. At follow-up after a week, the patient was stable and showed a patent-covered stent and complete aneurysm exclusion.

This case highlights the value of utilizing hybrid approaches when conventional endovascular methods are limited by anatomical challenges, particularly in high-risk patients where traditional open repair may carry an increased morbidity risk.

This case report describes a successful hybrid approach for the repair of a complex CAA. The hybrid approach, combining open surgical access with endovascular techniques, allowed for complete aneurysm exclusion and maintained the patency of the hepatic and splenic arteries. Hybrid repair can be a safer alternative to purely endovascular or open surgical approaches in complex CAA cases.

•Hybrid repair was successfully performed for a complex celiac artery aneurysm.•Initial endovascular repair failed due to anatomic barriers, necessitating a hybrid approach.•The procedure involved open surgical access, covered stent deployment, and branch embolization.•Completion angiograms confirmed aneurysm exclusion and patent hepatic and splenic arteries.•This case highlights hybrid repair as a viable alternative for anatomically challenging CAAs.

Hybrid repair was successfully performed for a complex celiac artery aneurysm.

Initial endovascular repair failed due to anatomic barriers, necessitating a hybrid approach.

The procedure involved open surgical access, covered stent deployment, and branch embolization.

Completion angiograms confirmed aneurysm exclusion and patent hepatic and splenic arteries.

This case highlights hybrid repair as a viable alternative for anatomically challenging CAAs.