A case of ruptured thoracoabdominal aortic aneurysm complicated with high aortic occlusion

We report a rare case of 76-year-old man who developed ruptured thoracoabdominal aortic aneurysm complicated with abdominal high aortic occlusion. His left limb was amputated due to Buerger's disease. CT showed that the aneurysm extended from the descending thoracic aorta to the upper part of the abdominal aorta and its had a maximum width of 68 x 83 mm. Angiogram revealed the aortic occlusion at the level of the left renal pelvis. We performed emergency operation, which was aneurysmectomy and replacement with artificial vascular graft, under femoro-femoral and subrenal aortic extracorporeal bypass. Because of the severe calcification at the subrenal aorta and the weak pulsation of the left renal artery, the bypass was placed from the aortic graft to the right lower limb and the left renal artery was reconstructed. Abdominal aortic occlusion might increase his hypertension and might cause aneurysmal change on the proximal aortic wall.