Abstract
We report a surgical case of a 79-year-old woman with thoracoabdominal aortic aneurysm complicated by emphysema. We planned a 2-stage hybrid repair of the aneurysm which consisted of the insertion of a stent graft into the thoracoabdominal aorta, excluding the branches of the visceral arteries, and bypass grafting to the visceral branches. In the first stage of the procedure, after aorto-bi-iliac repair of the infrarenal abdominal aortic aneurysm with a bifurcated Dacron graft, we attached a knitted quadrifurcated graft inversely from the left limb of the bifurcated graft to the celiac, superior mesenteric, and bilateral renal arteries. Subsequently, all 4 visceral arteries were double-ligated proximal to the site of anastomosis. Because follow-up computed tomography showed residual branches of the superior mesenteric artery proximal to the site of ligation, coil embolization was performed at the origin of the superior mesenteric artery. In the second stage of the procedure, the right limb of the bifurcated graft was accessed via a right retroperitoneal approach. Successful endovascular repair of the thoracoabdominal aortic aneurysm was performed from distal to proximal using 3 TAG endoprostheses. The postoperative course was uneventful and there was no occurrence of paraplegia.
