Visceral aortic patch aneurysm after thoracoabdominal aortic repair: Conventional vs hybrid treatment

A, Preoperative angioCT of a patient with previous type II thoracoabdominal aortic aneurysm (TAAA) open repair with a 62 mm VAP aneurysm. B, Intraoperative view of open repair of the VAP aneurysm with separate revascularization of the four visceral vessels with Coselli thoracoabdominal graft (Gelweave, Vascutek LTD, Renfrewshire, UK). C, Six month postoperative angioCT scan demonstrates VAP aneurysm resolution and patency of the four visceral vessels.

A, Preoperative angioCT scan of a patient with previous type III thoracoabdominal aortic aneurysm (TAAA) open repair with a 79 mm VAP aneurysm. Please note the complete displacement of visceral arteries origin with a stenosis at the origin of the celiac trunk (CT) and the superior mesenteric artery (SMA). B, Intraoperative view of the retrograde revascularization from the right common iliac artery of the right renal artery (RRA), of the superior mesenteric artery (SMA), and of the celiac trunk (CT). The right renal artery was dissected and prepared free from retroperitoneal adhesions after Kocker maneuver. Revascularization of the left renal artery was not performed because it could not be dissected safely due to its displacement by the VAP aneurysm and the tight adhesions of retroperitoneal tissue. C, Postoperative CT scan demonstrates complete exclusion with a Valiant stent-graft (blue) of the VAP aneurysm without endoleak and patency of the retrograde revascularization of visceral arteries (red).