Successful staged treatment of rapidly expanded thoracic aortic aneurysm following abdominal aortic aneurysm occlusion

We present the case of a 66-year-old man with aortoiliac occlusive disease (AIOD) complicated by mild abdominal aortic dilation and a thoracic aortic aneurysm (TAA). The patient first presented with intermittent claudication; imaging revealed bilateral common iliac artery stenosis with severe calcification and a dilated thoracic and abdominal aorta. The patient declined treatment and he was lost to follow-up for over two years. Upon returning to the hospital with worsening symptoms, imaging revealed aorto-bilateral iliac occlusion and significant progression of both thoracic and abdominal aortic dilation. Surgical intervention was again declined, and conservative management was continued. Three and a half years after the initial visit, the patient consented to a two-stage treatment. The first stage involved aorto-bifemoral bypass for the AIOD, which improved circulation and relieved symptoms. The second stage, performed three months later, involved thoracic endovascular aortic repair for the TAA. Both procedures were completed without complications, and the patient was discharged in stable condition. This case provides valuable insight into the progression of occlusive arteriosclerosis and aneurysms under conservative observation, highlighting the need for tailored, patient-centric approaches in vascular disease management.