Back to 2026 Abstracts
A Hybrid Approach For The Management Of Proximal Celiac Artery Aneurysms
Walker R. Ueland, MD, MBA, Zain Shahid, MD, Michael Fassler, MD, Salvatore T. Scali, MD, Thomas S. Huber, MD, PhD.
University of Florida, Gainesville, FL, USA.
DEMOGRAPHICS: Celiac artery aneurysms (CAA) are rare, accounting for <5% of visceral aneurysms, and the SVS Clinical Practice Guidelines provide little guidance regarding optimal treatment. Proximal CAAs (pCAAs) are particularly challenging to manage (
Figure 1A). Optimal repair requires revascularization of the hepatic artery and exclusion of the aneurysm; however, direct exposure is difficult, and oversewing the pCAA is not feasible due to poor tissue quality. Definitive repair has traditionally required paravisceral aortic replacement combined with CA bypass. We have developed a novel sequential, hybrid approach to the management of these complex pCAAs that addresses these technical limitations.
HISTORY: We retrospectively reviewed 4 consecutive patients with pCAA treated from 2023-2025 using a hybrid strategy combining retrograde mesenteric bypass with endovascular aortic exclusion (
Figure 1B). Demographics, comorbidities, procedural details, and perioperative outcomes were abstracted. The primary outcome was perioperative technical (pCAA exclusion); secondary outcomes included mortality, complications, survival, and reintervention.
PLAN: All patients were male, mean age was 66.8±7.2 years, with mean (+/- SD) pCAA diameter 2.7±0.2cm due to an incidental finding (n=3) or prior CA dissection (n=1). All underwent retrograde mesenteric bypass (aorto/CA, n=3, aorto/SMA/CA, n=1) with ligation of the proximal common hepatic, splenic, and left gastric arteries followed by endovascular exclusion of the pCAA origin. Endovascular exclusion employed either a physician-modified endograft (PMEG, n=2) or an endovascular aortic cuff (n=2). One case was staged, 3 were simultaneous. pCAA exclusion was 100%, with an average sac regression of 1.5±0.5 cm over 186±115 days. There were no perioperative deaths. Complications occurred in two patients (25%, pneumonia; 25%, delayed type II endoleak treated with embolization). Mean LOS was 11±6 days. One patient died within 1-year postoperatively from an unknown cause. All grafts remained patent at 1-year follow-up, with an average follow up of 463±353 days.
DISCUSSION: Hybrid repair of pCAAs with retrograde mesenteric bypass, branch vessel ligation, and endovascular exclusion of the celiac origin is a safe and effective strategy that avoids paravisceral aortic replacement. This novel approach addresses a rare but formidable problem for which current guidelines provide little direction and represents our preferred strategy for managing this complex presentation.
Figure 1. A) Preoperative CTA with pCAA measuring 3cm in diameter. B) Postoperative CTA after combined endovascular exclusion via 4v PMEG and retrograde aorto-hepatic bypass.
Back to 2026 Abstracts
