Staged thoracic and abdominal aortic aneurysm repair using stent graft technology and surgery in a patient with acute renal failure

A 52-year-old male presented with severe hypertension and acute renal failu re. Carbon dioxide (CO2) angiography identified a saccular thoracic aortic aneurysm, right renal artery stenosis, left renal artery occlusion, an infr arenal aortic aneurysm, celiac artery, and inferior mesenteric artery (IMA) orificial stenoses. Via an anterior retroperitoneal approach, bilateral re nal artery thromboendarterectomy, infrarenal aortic aneurysmectomy, and IMA reimplantation were performed. The patient's tortuous iliac arteries were straightened to permit future passage of a thoracic stent graft by mobilizi ng the aortic bifurcation and anastomosing it to a Dacron graft within 4 cm of the renal vessels. Two weeks later, a stent graft was placed via a femo ral incision utilizing CO2 angiography, successfully excluding the saccular thoracic aneurysm. Recovery from both procedures was quick, with rapid ret urn of renal function, and alleviation of the hypertension. At 8 months fol low-up, his renal arteries and aorta are patent.