We operated on a 68 year-old male patient who presented with a symptomatic type IV thoracoabdominal aortic aneurysm (TAAA). He had a history of a standard endovascular repair of an infrarenal abdominal aortic aneurysm about 6 years ago. Following the primary repair, he had developed a type Ia endoleak, and due to this a huge aneurysm of 12 cm maximal diameter. The aorta on the level of the renal arteries was 44 mm wide.
On the abdominal CT scan, signs of pending rupture were found. He underwent an open repair as a type IV TAAA aneurysm after the previous endograft was explanted.
The approach was through a bilateral subcostal incision (roof-top approach), and a left-sided visceral rotation. The aorta was clamped at a supraceliac level, the endograft was removed and a bevelled proximal anastomosis was performed with a tube Dacron graft 20 mm wide. The duration of splachnic ischemia was 34 minutes. The distal anastomosis was at the abdominal aorta bifurcation.
The patient had an uneventful recovery. His serum creatinine level rised to 4.6 mg/ dl (baseline of 1.0) within the first 4 postoperative days, and fell to 2.6 on his exit at the postoperative day 8.