Hybrid Approach for Thoracoabdominal Aneurysm
The purpose of this article is to report successful hybrid treatment of a sovraprosthetis type IV thoracoabdominal aneurysm.

This technique was used in a 65-year-old man with chronic rupture of a type IV thoracoabdominal aneurysm not suitable for aortic cross-clamping because of a severe cardiopathy (left ventricular ejection fraction 20%); the patient underwent previous repairs of aortic arch and infrarenal abdominal aortic aneurysms. Perioperative complications were absent. Postoperative day 21 computed tomography and monthly duplex ultrasonography confirmed the complete exclusion of the aneurysm with proper perfusion of visceral vessels. At the seventh postoperative month, the patient died of a massive recurrence of myocardial infarction.

Hybrid treatment for thoracoabdominal aneurysms may represent a valid solution for those patients with poor cardiac and respiratory reserve, reducing cardiac stress and the duration of visceral ischemia, which are still the main causes of morbidity and mortality for this type of intervention.

Surgical treatment of type IV thoracoabdominal aneurysms (TAAs) involves important technical problems. Aortic substitution and implantation of visceral vessels according to Crawford and colleagues' inclusion patch technique have high rates of mortality (5–17%), and morbidity (5–20%), involving cardiac, renal, and respiratory insufficiency and spinal cord ischemia., Although endovascular treatment for abdominal, and thoracic, aneurysms is standardized, endografting in the thoracoabdominal aorta is seldom applied owing to technical difficulties concerning secondary branches or stent implantation for revascularization of visceral vessels., In the management of this complex lesion, performing hybrid treatment avoids the trauma of open surgery and the technical difficulties of the endovascular procedure.