Combined endovascular and surgical approach (CESA) to thoracoabdominal aortic pathology: A 10-year experience

A, transesophageal echocardiography used during the second stage deployment of the endovascular grafts. B, in this particular case, the endograft was deployed in the false lumen as identified by the transesophageal echo, between the previously placed proximal descending thoracic aortic graft, and an infrarenal aortic graft placed during the first stage of the procedure.

Intraoperative picture of a first stage procedure with retrograde grafts to both renal arteries, the superior mesenteric artery, and the celiac artery. Note the placement of a conduit that was left in the subcutaneous tissue and successfully used during the second stage. Marker clips are placed to help fluoroscopically identify the most distal landing site for the endografts during the second stage of the procedure. R, right; SMA, superior mesenteric artery.

Computed tomography (CT) scan with three-dimensional reconstruction 10 years after endovascular and surgical repair of a type IV thoracoabdominal aneurysm performed in 1998 and reported in 1999 (see text).