Combined open and endovascular techniques for the treatment of complex vascular disease.

In an attempt to improve the outcome following aortic aneurysm repair, there has been an increased focus on endovascular technology as a minimally invasive means of treating various vascular pathologies. Stent-grafting of aortic aneurysms is an area where a less invasive approach may decrease the morbidity seen with conventional aneurysm repair. As with other technologies, increased experience and improvements in instrument design allow for applicability to a broader population of patients. However, despite such improvements, some patients' anatomic characteristics may make endovascular repair unsuitable or too risky. When complex anatomy prohibits repair by endovascular means alone, a combination of conventional surgery and endovascular therapy may be utilized in an effort to minimalize the invasiveness. Using adjunctive surgical procedures, complex anatomy may be modified to allow for a safe and successful endovascular aneurysm repair. In this paper, we describe the modification of access vessels as well as fixation sites to facilitate the endovascular treatment of aortic aneurysms.