Replacement of the descending thoracic aorta after stent-graft failure

Open surgery after failed endovascular aortic repair remains an important therapy. The potential modes of stent-graft failure include: type I endoleaks; progression of the aortic disease at the landing zones or proximal/distal to them persistent false lumen perfusion in post-dissection aneurysms; retrograde aortic dissection; stent-graft infection; and stent-graft collapse, fracture, or dislocation. The mortality associated with those procedures can be up to 20% depending on the complexity of the operation and the comorbidities of the patient, especially the presence of graft infection.  In this video tutorial we present the case of a young patient with a 7-cm pseudoaneurysm of the descending thoracic aorta following aortic coarctation repair. Initial stent-graft therapy failed due to type I endoleak. Open surgery with stent-graft explantation and replacement of the descending thoracic aorta was performed. The details of the operation are shown in the step-by-step video.