A hybrid approach to multiple endoleaks in a patient with situs inversus totalis

Situs inversus totalis (SIT) is a rare congenital condition characterized by mirror image transposition of thoracic and abdominal organs. The coexistence of SIT and abdominal aortic aneurysm presents unique anatomical and surgical challenges. We reported a case of a 60-year-old male with SIT and a history of endovascular aneurysm repair who developed multiple endoleaks (T1bEL, T2EL, and T3EL). A hybrid procedure combining open surgical repair and endovascular techniques was successfully employed to address the complex endoleaks (ELs). The procedure included ligation of collateral vessels, stent-graft extension, and preservation of the right internal iliac artery using an artificial vessel. This case highlights the feasibility of a hybrid approach for managing ELs in patients with SIT and underscores the importance of tailored surgical strategies.