Abstract
A 50-year-old man was hospitalized prior to undergoing surgery to remove a residual aortic aneurysm, which had expanded to 62 mm between descending thoracic and thoracoabdominal aortic artificial grafts. When he was 46 years old, he had undergone replacement of the proximal descending aorta because of chronic aortic dissection (DeBakey IIIb), and replacement of the artificial graft had been performed using a Coselli thoracoabdominal graft to reconstruct 4 abdominal branches, and a bifurcated graft for a thoracoabdominal aortic aneurysm (Crawford III) at age 47. During the present surgery, stent graft treatment was performed to reduce the risk of lung injury and bleeding caused by synechiotomy after 2 left thoracotomy procedures. Since the distal portion of the neck of the aortic aneurysm was short, and the landing zone of the stent graft distal end covered the abdominal branches of the previous thoracoabdominal artificial graft, hybrid endovascular repair was performed, in which the stent graft was deployed, after revascularization to the splenic artery and superior mesenteric artery. He improved and was discharged from the hospital without developing any complications. Hybrid therapy for residual aneurysm between grafts after replacement for the descending thoracic and thoracoabdominal aortas may increase the flexibility of the landing zone of the stent graft distal end, and thus is considered to be a safe and minimally-invasive treatment, especially for patients who may have lung injury caused by synechiotomy after left thoracotomy procedures.
