Staged Extensive Thoracic Aortic Aneurysm Repair at Mount Sinai-St. Luke's Medical Center

Elderly woman who presented with back pain was discovered on CT scan to have an extensive thoracic aortic aneurysm. The aortic aneurysm extended from the aortic arch to the aortic bifurcation. After careful pre-operative work-up she was offered repair of the thoracic aortic aneurysm in a staged manner (see video) in order to reduce her risk of spinal cord ischemia. The first stage was an aortic arch replacement with an elephant trunk using hypothermic circulatory arrest. Her Type II thoracoabdominal aortic aneurysm had a narrowing at the level of the diaphragm which allowed us to perform a Type IV thoracoabdominal aortic aneurysm repair with a separate branched graft to all the visceral arteries and renal arteries (Stage II). A few months later she underwent a TEVAR bridging the elephant trunk to the graft used for the thoracoabdominal aortic repair (Stage III). Patient did well with preserved spinal cord function and is currently doing well. The 3-D reconstruction shows complete repair of the extensive thoracic aortic aneurysm.