Combined surgical and endovascular treatment of pseudoaneurysms of the visceral arteries and of the left iliac arteries after thoracoabdominal aortic surgery.

A 60-year-old man who 10 years earlier underwent replacement of a thoracoabdominal type B dissecting aortic aneurysm with a Dacron graft, was admitted for an 8 cm pseudoaneurysm involving the coeliac axis, the superior mesenteric artery (SMA) and the right renal artery, and a 3 cm pseudoaneurysm involving the left iliac arteries (Fig. 1). During the primary procedure, the coeliac axis, the SMA and the right renal artery were anastomosed as a single inclusion patch, and the left renal artery separately. A bifurcated graft was then anastomosed to the iliac arteries. The patient had a history of heavy smoking, alcohol abuse, severe, untreated hypertension, pneumonia, and gastric resection for gastric bleeding. During the last year, the patient complained of several episodes of abdominal and right flank pain associated with vomiting and weight loss of about Fig. 1. CT scan showing pseudoaneurysms involving the coeliac axis, the superior mesenteric artery and the left iliac arteries. ∗ Please address all correspondence to: T. Juvonen, Department of Cardio-thoracic and Vascular Surgery, Oulu University Hospital, P.O. Box 22, 90221 Oulu, Finland.