RESUMO
The objective of aneurysm surgery is to exclude the aneurysm from the circulation while preserving blood flow distal to the lesion. In certain situations, the aneurysm neck cannot be clipped safely or the parent vessel reconstructed, primarily in large or giant size with incorporation of parent vessels or perforating arteries, calcification at the aneurysm base, and fusiform or dissecting aneurysms. In such cases, occlusion of the parent vessel is a treatment of option. In many patients, however, sacrifice of the parent artery has an associated risk of ischemic stroke. Therefore, sacrifice of the parent vessel can be supplimented with distal revascularization to provide the necessary distal blood flow while allowing the aneurysm to be trapped. The indications, options, and surgical approaches are described with review of literatures. Finally the authors' experiences of revascularization in 7 patients with unclippable aneurysms are reported.