This study clearly depicts that the Techniques in endovascular thoracoabdominal aortic aneurysm (TAAA) repair continue to evolve with custom-made fenestrated and branched devices. The availability of these grafts is limited, can be costly, and may require significant radiation and contrast material load. We describe here a patient for whom we performed endovascular TAAA repair using a combination of off-the-shelf endovascular devices.

A 78-year-old woman with history of sigmoid diverticulitis presented with an expanding, multilobular type III TAAA (maximum diameter, 5.2 cm) with a narrow, calcified distal aorta and proximal iliac arteries. A total endovascular approach was devised, employing stent graft components from various platforms in a staged fashion. Stage I consisted of thoracic endovascular aortic repair using two C-TAG stent grafts (W. L. Gore & Associates, Flagstaff, Ariz) extending from the mid-descending thoracic aorta to the celiac trunk. Seven months later, after interval open colectomy, stage II consisted of building an anatomically fixated distal aortoiliac platform from which the paravisceral segment could be addressed. This would also forgo the need for contralateral gate cannulation in a narrow, heavily calcified aorta and concomitantly address the aortoiliac occlusive disease. This was accomplished percutaneously using the AFX bifurcated unibody endograft.

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