ABSTRACT
We report an unusual case of type IV thoracoabdominal aneurysm (TAA) with superior mesenteric artery (SMA), celiac artery, and bilateral renal artery aneurysms in a patient who underwent repair of two infrarenal abdominal aortic aneurysm (AAA) ruptures. Due to the presence of four visceral artery aneurysms and earlier transabdominal and retroperitoneal operations, surgical treatment through either approach using an inclusion grafting technique was considered difficult. A combined surgical approach achieving retrograde perfusion of all four visceral vessels and endovascular grafting allowing exclusion of the TAA was recommended. The procedure was performed in 1998 and the patient has been followed for 23 years. Complete exclusion of the aneurysm and normal perfusion of the patient's viscera were initially documented by CT imaging at 3 and 6 months and every year thereafter. The repair of a type IV TAA with a combined endovascular and surgical approach (CESA) allowed us to manage both the aortic and visceral aneurysms without thoracotomy or re-do retroperitoneal exposure while minimizing visceral ischemia time. The durability of this approach is now confirmed and represents an alternative in patients with complex aortic pathology.
