CESA – A New Modality for the Difficult Aortic Aneurysm

A thoracic aortic aneurysm (TAA) is a life-threatening condition with a 20% five-year survival in untreated patients. Rupture is invariably fatal. Surgical repair should be considered when the aneurysm is >6cm in diameter, rapidly enlarging, or impinging on adjacent structures. Open repair, via a left thoracotomy carries significant morbidity and mortality rates. More recently, endovascular repair of TAA has become an acceptable alternative to open repair with lower peri-operative morbidity and mortality rates.The combination of both open and endografting techniques has further expanded the options for treatment of TAA especially for complex lesions which involve the visceral arteries. We present a case of combined endovascular and surgical approach (CESA) for the treatment of a TAA in a patient with a previous open abdominal aortic aneurysm (AAA) repair.