A distal-first open approach with sequential visceral perfusion and left heart bypass via a graft sidearm allowed successful emergency thoracoabdominal aortic repair in a 59-year-old man with two prior aortic repairs, with the patient discharged home at 5 weeks with a patent repair.
A 59-year-old haemodialysis-dependent man with two prior aortic repairs presented with a 74 mm descending thoracic aortic aneurysm with impending rupture features and required emergency open repair.
Multidisciplinary consensus judged further endovascular intervention unsuitable, so emergency open thoracoabdominal repair was undertaken.
A distal-first approach was used to overcome the distal perfusion challenges imposed by chronic aortic dissection.
Visceral and renal vessels were reconstructed in sequence, with sequential visceral perfusion during the repair.
The proximal anastomosis incorporated both the previous frozen elephant trunk and the thoracic endovascular stent graft, reinforced with double Teflon strips, and the intercostal arteries were reimplanted.
Neuromonitoring remained preserved during the operation.
The patient recovered well and was discharged home 5 weeks after surgery with a patent repair on imaging.
This report describes an emergency operation on a 59-year-old man whose aorta (the body's main artery) had already been repaired twice. He was on kidney dialysis and had earlier surgery for an aortic dissection, followed by a stent graft, which led to a leak and temporary partial spinal cord injury. He then came in with chest pain and a 74 mm bulge in the aorta that looked close to rupturing. The care team decided that another stent-based procedure was not suitable, so surgeons performed open repair. They worked from the lower part of the aorta upward, which helped maintain blood flow to the lower body despite the chronic dissection. They used a branched graft, supported circulation with a bypass connection, fed the abdominal organs sequentially, and reattached the key organ arteries and spinal-supplying arteries. Nerve-function monitoring stayed preserved throughout. The patient recovered well, went home after 5 weeks, and imaging showed the repair was open and working. This is a single case report, so it suggests that this approach can be feasible in very complex situations but cannot show how well it works in other patients.
Naruka V, Kumar U, Rasheed I, Lopez-Marco A, Adams B, Ye Oo A. (2026). Emergency thoracoabdominal aortic repair: distal-first approach with two previous aortic repairs.. Multimedia manual of cardiothoracic surgery : MMCTS. https://doi.org/10.1510/mmcts.2026.089