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A Unique Case of Endovascular Repair of Aortic Aneurysm

Abhisekh Mohanty

A 57 year old asymptomatic male who is a smoker and a known case of Diabetes mellitus and hypertension was diagnosed as a case of suprarenal thoracoabdominal aortic aneurysm which included the origin of superior mesenteric artery (SMA) and celiac artery (CA). The origin of the CA SMA are occluded and are supplied retrogradely through extensive collaterals from the inferior mesenteric artery (IMA). In thoracoabdominal aneurysms which include major side branches, usually we need to go for hybrid procedures or use of custom made branched stent grafts to maintain the patency of the side branches. This increases the operative time, operative complications as well as the cost of procedure. But in our patient, because of the occluded mesenteric arteries and extensive collaterals from IMA, we used a conventional graft stent across the aneurysmal segment covering the SMA and CA origin. Hence the operative time and procedural cost was significantly reduced by the ‘natural bypass’ which is revascularising the CA and SMA.