Hybrid repair of the complex celiac artery aneurysm.

introduction and importanceCeliac 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. CASE PRESENTATION: 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. CLINICAL DISCUSSION: 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.

conclusionThis 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.