[Thoracoabdominal Aneurysm in a Patient with an Axillo-bifemoral Bypass]

We report an extremely rare case of thoracoabdominal replacement after left axillo-bifemoral artery bypass surgery. The patient was a 33-year-old man who had undergone left axillo-bifemoral artery bypass surgery after total arch replacement due to lower extremity ischemia by stenosis of the elephant trunk graft 10 years previously. He was admitted to the emergency department with back pain. Computed tomography (CT) revealed an acute aortic re-dissection and a thoracoabdominal aneurysm. Due to gradual increase of the size of aneurysm, thoracoabdominal replacement was performed. The fourth intercostal thoracotomy with stony extension was performed without cutting the axillofemoral bypass graft. A separate graft was attached to each of the axillofemoral artery bypass grafts to use perfusion sites after transecting the axillo-femoral bypass. Since lower extremity blood flow improved after reconstruction, the axillofemoral artery was transected. The postoperative course was uneventful. Thoracoabdominal replacement after left axillofemoral artery bypass surgery requires some ingenuity in thoracotomy and on extracorporeal circulation.