Abstract
A 73-year-old man presented complaining of pain and numbness in the right leg. MDCT showed an infrarenal abdominal aortic aneurysm 4.8 cm in maximum diameter which had completely thrombosed, extending from just below the bilateral renal arteries to the bilateral external iliac arteries. This was a case of high aortic occlusion. The bilateral common femoral arteries were visualized via collateral circulation. The right superficial femoral artery was also occluded. Because the superior mesenteric artery arose from the same level as the bilateral renal arteries, it was difficult to clamp the aorta for anatomical bypass. In addition, due to his poor pulmonary function we selected an extra-anatomical bypass (axillo-bifemoral bypass graf) and a right femoro-popliteal bypass grafting without aneurysmectomy. The postoperative course was uneventful. There was no change in the diameter of the aneurysm or thrombosis 2 years later. In this type of case careful postoperative observation is needed because of the possibility of delayed aortic rupture and thrombotic progression into the proximal abdominal aorta.
