Staged Repair of a Type 3 Thoracoabdominal Aortic Aneurysm with Takayasu Arteritis Post Left Nephrectomy

Surgical management of thoracoabdominal aortic aneurysms (TAAAs) is challenging and requires good preoperative planning. We present a 38-year-old woman, with Takayasu arteritis, post left nephrectomy for hypofunctioning, atrophic kidney, with type 3 TAAA, right renal artery (RA) and left common iliac artery (CIA) stenosis, and right CIA occlusion. Considering the need to salvage the precious right kidney at all costs and to reduce cardiopulmonary bypass (CPB) time, we planned a staged repair for the patient. In the first stage, the infrarenal aorta was repaired and visceral debranching to the hepatic, superior mesenteric, right renal, and right common femoral arteries was done. The patient was resuscitated overnight. The next day, repair of the remaining aneurysmal segment was done under partial CPB. The patient tolerated the procedure well, and on follow-up, all bypass grafts were patent. The procedure is surgically demanding, but it allowed the correction of the right RA stenosis and decreased the duration of CPB.