Hybrid procedure for combined descending thoracic and abdominal aortic aneurysms

In patients with previous infrarenal abdominal aortic aneurysm (AAA) repair, the risk of spinal cord ischemia increases after thoracic endovascular aortic repair (TEVAR) for a descending thoracic aortic aneurysm (DTAA). The case is a 67-year-old man with a 60 mm infrarenal AAA and a 73 mm DTAA. We performed the staged hybrid procedure for these aortic aneurysms. First of all we underwent a conventional AAA repair. The bilateral internal iliac arteries and a inferior mesenteric artery were preserved. In addition, the right leg of the tube graft was anastomosed to the right superficial femoral artery to facilitate access of TEVAR. Two months later we performed TEVAR for the DTAA. DTAA extended from the level of the 7th thoracic vertebra to that of the 11th thoracic vertebra. Although there was a certain risk of paraplegia, no complications occurred. The hybrid procedure for combined DTAA and AAA may be a valuable option.