Endoluminal repair of infrarenal AAA in the presence of aortic dissection.

Objective: To report a challenging case of infrarenal abdominal aortic aneurysm (AAA) treated with a commercial stent-graft in the face of thoracoabdominal aortic dissection.

Methods: A 73-year-old patient was admitted because of acute descending thoracic and abdominal aortic dissection. He was also found to have an 8-cm infrarenal AAA. After initial medical management of the acute aortic dissection, the patient underwent endoluminal AAA repair with an AneuRx stent-graft. The completion angiogram showed that the graft was deployed in the false lumen; this complication was treated with fenestration of the intimal flap, establishing flow through both lumens. The patient's recovery was uneventful, and he was discharged on the fourth postoperative day. Follow-up at 1 year with computed tomographic angiography documented a stable descending thoracic aorta with a suggestion of a type II endoleak and no change in the aneurysm volume.

Conclusions: This case illustrates the feasibility of endograft repair of infrarenal AAA with a modular stent-graft in the presence of aortic dissection extending below the renal arteries.