Sequential Hybrid Repair of Aorta and Bilateral Common Iliac Arteries Secondary to Chronic Aortic Dissection with Extensive Aneurysmal Degeneration in a Marfan Patient

Fig. 1. Chest computed tomography angiography demonstrates the maximum diameters of the ascending aorta in (A) axial view (7.74 cm) and (B) lateral view (8.13 cm).

Fig. 2. Chest computed tomography angiography shows the maximum diameters of the descending thoracic aorta in (A) axial view (6.6 cm) and (B) lateral view (6.1 cm).

Fig. 3. Computed tomography angiography three dimensional reconstruction of the aorta demonstrates the type 1 DeBakey aortic dissection and aneurysmatic segments in the ascending and the descending thoracic aorta.

Fig. 4. Follow-up computed tomography angiography three dimensional reconstruction of the aorta from 2012, revealed the chronic dissection and extensive aneurysmal degeneration of the thoracoadominal aorta (measuring 6.4 cm) extending to both common iliac arteries (measuring 2.3 cm in the right and 2.9 in the left).

Fig. 5. (A) The thoracic aorta endograft was clamped just above the diaphragm and the aorta and vessels reconstruction was performed using a 22 mm five-branched Dacron graft. (B) Finally, a bifurcated 20×10 mm graft was anastomosed to the distal tube graft and its limbs distally to the common iliac arteries bilaterally.

Fig. 6. (A) At 5 years from her last surgery, a computed tomography angiography three dimensional reconstruction revealed no new dissection in the remaining aorta or aneurysmal degenerations. (B) Schematic drawing of the sequential hybrid aortic and bilateral iliac aneurysm repair showing the components of the prosthetic material utilized for the complex reconstruction.