Hybrid approach to complex thoracoabdominal aneurysm: a case report

Introduction: Thoracoabdominal aortic aneurysms (TAAA) represent a life-threatening vascular pathology, not only due to the high risk of catastrophic complications such as rupture and death, but also due to the complexity of their management. In addition to conventional open surgery which is associated with significant perioperative risk, especially in elderly patients or those with multiple comorbidities total endovascular repair has emerged as a less invasive alternative. Techniques such as fenestrated stent grafts and branched stent grafts have demonstrated feasibility in selected cases. However, the challenging anatomical configuration of TAAA often renders total endovascular approaches technically demanding and cost-prohibitive. For selected patients with Crawford type III, IV, or V TAAA, the hybrid approach, which combines open surgical debranching of visceral arteries followed by endovascular exclusion of the aneurysm, has become a viable treatment option that bridges the gap between traditional open repair and total endovascular strategies. Objective: We report a case of Crawford type III TAAA successfully treated using a hybrid technique, and share our surgical experience as well as short-term postoperative outcomes. Methods: This is a case report of a patient diagnosed with Crawford type III thoracoabdominal aortic aneurysm who underwent hybrid repair. The treatment consisted of two stages. Stage 1: Surgical debranching of the celiac trunk, superior mesenteric artery, and bilateral renal arteries, with revascularization to the bilateral common iliac arteries. Stage 2: Endovascular placement of a thoracoabdominal stent graft to exclude the aneurysmal segment. The patient was followed postoperatively, and a type II endoleak was identified and managed successfully. Conclusion: In this case, hybrid repair of Crawford type III TAAA proved to be both safe and effective. Although limited to a single case, the result suggests that hybrid repair is a feasible treatment option. Larger studies and longer follow-up are necessary to validate its long-term outcomes and role in the management of complex TAAA.