Axillary-femoral hypogastric bypass for spinal cord protection during fenestrated, branched endovascular repair of post-dissection thoracoabdominal aortic aneurysm

We present a case of a 65-year-old male who previously underwent left axillofemoral bypass, left carotid stenting, and right iliac stenting followed by ascending and hemiarch repair for type A aortic dissection, complicated by left external iliac artery occlusion. He presented to our center with a symptomatic 8.5cm post-dissection extent II thoracoabdominal aortic aneurysm. A staged repair was performed to decrease spinal cord ischemia. The first stage employed the novel use of a jump graft from the left axillary-femoral bypass to the left internal iliac artery to restore pelvic circulation, combined with zone 2 thoracic branched endoprosthesis (TBE). The second stage included thoracic endovascular repair (TEVAR) extension and 3-vessel custom-modified fenestrated/branched endovascular repair (FBEVAR).