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Aortic aneurysms and treatment thereof continue to challenge the vascular surgeon. The natural history of aneurysms has been well documented, and the indica- tion for treatment extensively discussed [56]. The goal of treatment is to prevent aneurysm rupture and distal embolization. It is well known that aneurysm size is the most important criterion determining the main risk, namely rupture. Arterial hypertension is the second most important parameter that influences this risk, according to Laplace’s law (tension on the wall is produced by the product of pressure and radius). As experience has accu- mulated, the durability of open surgical therapy, which was introduced over 50 years ago, has also been well doc- umented [29]. In contrast, there are very few data on the long-term durability of endovascular aneurysm repair (EVAR), which was introduced as a new approach about 15 years ago [45].

The infrarenal aorta and its branches supply a very large anatomical area which includes the walls of the inferior part of the abdomen, the walls of the pelvis, the descend- ing colon, the viscera of the pelvis, the reproductive or- gans and the inferior limbs. For this reason, acute infra- renal aortic occlusion is a catastrophic event. In contrast, chronic obstructive aortoiliac disease can be asymptom- atic. It depends on how quickly the disease develops, its extent and the development of collateral circulation. In- deed, the branches of the aortoiliac artery develop a large anastomotic, parietal, visceral and parieto-visceral circu- lation. This is fundamental in the context of the physiopa- thology of aortoiliac obstructive disease. mesenteric arteries.

The use of minimally invasive laparoscopic techniques has expanded in recent years. As in other specialties, these techniques are becoming increasingly prevalent in vascular surgery. For aortic repair best results in terms of long-term patency are obtained by conventional sur- gery but its associated short-term morbidity and mortal- ity have not changed in the last 10 years. This situation created an opening for endovascular techniques that are much less invasive but with less reliable long-term results. In addition to endovascular surgery, video-endoscopic aortic surgery has been proposed as an alternative to con- ventional open surgery and is considered by some as a veritable third solution. The advantages of minimally in- vasive surgery are shorter intensive care and hospital stay, quicker resumption of intestinal transit, requirement for less analgesic and fewer abdominal wall complications. But specialized training is required to master the pro- cedure and to become acquainted with the coelioscopic practice necessary for laparoscopic suture.

Since the recent publication of EVAR Trial I [23] and DREAM [29], endovascular aneurysm repair (EVAR) has proven superior results versus open surgical repair con- cerning 30-day mortality and morbidity. It is now well enough established that EVAR is feasible, efficacious and has proven considerable benefits over conventional open surgery in many aspects; namely, duration of operation, blood loss, length of hospital and intensive care unit stay, quality of life (QOL) and 30-day mortality and morbid- ity [11,14,21,23,29,30]. Moreover, midterm results of EVAR are sufficiently encouraging to justify the proce- dure, especially in high-risk patients [6,11,15,17,30,40, 51,63]. However, some publications have raised concerns about the long-term results of the procedure [4,24,26,43]

Aneurysms of the renal and intestinal arteries are rela- tively rare. In 1970, Stanley et al. [17] and Deterling [6] published a review of the compiled clinical experience of the prevalence, diagnosis and treatment of 1500 aneurysms of the intestinal arteries as published in the literature [17]. Since then,in an additional 50 articles, “case reports” have often been published [9]. Recently, an overview of demographic data concerning the prevalence,diagnosis and treatment has been presented [16].

Acute intestinal or mesenteric ischaemia may have sev- eral causes:

Lower limb arterial recanalization is a term that encom- passes various therapeutic manoeuvres with the goal of re-opening or dilating occluded and stenotic arteries. . Percutaneous transluminal angioplasty (PTA) and stents are,at present, accepted as effective treatment in a substantial portion of iliac artery lesions [52]. The role of endovascular repair in the femoro-popliteo-crural system is still the subject of debate [37,55]. Percutaneous revascularization of femo- ro-popliteal arteries has shown high restenosis rates and stents should be confined to flow-limiting dissections or where there have been inadequate results from balloon angioplasty alone [27].

Disorders of the vascular system are the leading causes of death and disability in the western world. One of the most debilitating forms of vascular disease is peripheral arterial occlusive disease when it is manifested as critical limb ischaemia. Patients with limbs threatened by distal tibioperoneal occlusive disease present an ongoing chal- lenge to the vascular surgeon.