Management of Complex Abdominal Aortic Aneurysms: An Institutional Experience with Open and Endovascular Repairs

Background: Complex abdominal aortic aneurysms (AAAs), including juxtarenal, pararenal, paravisceral, and thoracoabdominal aneurysms, present significant technical and perioperative challenges. In resource-limited public healthcare settings, open surgical repair continues to play a major role alongside endovascular techniques. Methods: We conducted a retrospective descriptive case series of six patients with complex aortic aneurysms managed at the Institute of Vascular Surgery, Madras Medical College, and Rajiv Gandhi Government General Hospital, Chennai, India. Four patients underwent open surgical repair with visceral debranching and endoaneurysmorrhaphy, while two underwent thoracic endovascular aneurysm repair (TEVAR). Operative techniques, renal protection strategies, complications, and short-term outcomes were analyzed. Results: Etiologies included atherosclerosis, Takayasu arteritis, and infective (tuberculous) aneurysm. Open repairs utilized supraceliac clamping, cold renal perfusion, carrel patch reimplantation, and multibranch graft reconstruction. One patient developed an enterocutaneous fistula managed successfully. No perioperative mortality was observed. Endovascular repairs demonstrated complete aneurysm exclusion without early endoleaks. Conclusion: Complex AAAs can be managed effectively in public-sector tertiary centers using tailored open and endovascular approaches. Open repair remains indispensable in inflammatory and infective aneurysms, while TEVAR provides excellent short-term outcomes in anatomically suitable patients.