Hybrid approach to thoracoabdominal aortic aneurysms in patients with prior aortic surgery

A, Preoperative computed tomography angiography (CTA) scan shows a type II thoracoabdominal aortic aneurysm (TAAA) in a previous unsuccessful attempt of open and endovascular thoracic aneurysm repair. B, Intraoperative photograph shows the creation of an infrarenal neck with grafting of aneurysmatic aorta and two customized Y grafts directed to the renal arteries, the celiac trunk and the superior mesenteric artery. C, Postoperative CTA and drawing D, shows patency of the Y grafts and correct deployment of the thoracoabdominal endograft with complete aneurysm exclusion of the TAAA.

A,Preoperative computed tomography angiography (CTA) shows a type I thoracoabdominal aortic aneurysm (TAAA) in a previous AAA repair. B, Intraoperative photograph shows the detail of the customized Y graft directed to the celiac trunk and superior mesenteric artery from the right common iliac artery. Postoperative CTA shows patency of the Y graft and correct deployment just above the renal arteries with aneurysm exclusion of the TAAA of the thoracoabdominal endograft.