# Staged Endovascular and Open Surgical Repair of Multiple High-Risk Thoracoabdominal Aortic Aneurysms Following Initial Presentation With a Ruptured Juxtarenal Aneurysm: A Case Report

## TL;DR

A patient with multiple aortic aneurysms was successfully treated using a staged approach combining endovascular and open surgical techniques.

## Contribution

This case demonstrates a safe and effective staged strategy for treating complex aortic aneurysms while minimizing spinal cord ischemia risk.

## Key findings

- Staged repair of multiple aortic aneurysms was completed without neurologic or renal complications.
- Combining EVAR, TEVAR, and open arch replacement allowed complete treatment of extensive aortic disease.
- Prioritizing rupture risk in treatment sequence enabled successful outcomes in high-risk patients.

## Abstract

Simultaneous repair of extensive aortic aneurysms carries a high risk of spinal cord ischemia. Staged repair is one strategy to reduce this risk; however, aneurysm rupture during the interval is a concern. A 74-year-old man presented with a ruptured juxtarenal abdominal aortic aneurysm (AAA). A CT scan revealed a large (87 mm) ruptured AAA, a 95-mm descending thoracic aortic aneurysm (TAA), and an 80-mm saccular aneurysm in the aortic arch. Emergency EVAR (endovascular aneurysm repair) and right renal artery embolization were performed. Two weeks later, TEVAR (thoracic endovascular aortic repair) was completed for the descending TAA. At six weeks post-initial intervention, open arch replacement with open stent graft technique was performed. The patient had no neurologic or renal complications. Staged repair, prioritizing rupture risk, can allow the complete and safe treatment of extensive aortic disease without major complications.