Three-Staged Surgical Hybrid Treatment for an Extended Thoracoabdominal Aneurysm in a High-Risk Patient: A Case Report

Thoracoabdominal aortic aneurysm (TAAA) repair remains one of the most challenging procedures and is associated with high mortality and complication rates. Careful consideration of the surgical strategy is essential, particularly in cases involving extensive replacement and high-risk patients. A 61-year-old man with a 55-mm TAAA was referred for surgical treatment. Seven years earlier, he had undergone artificial vascular replacement for an infrarenal abdominal aortic aneurysm. His medical history included a myocardial infarction with a left ventricular ejection fraction (LVEF) of 20% and an apical thrombus. Additionally, he had chronic kidney disease, cerebral infarction, angina pectoris, hypertension, dyslipidemia, diabetes mellitus, and hyperuricemia. The preoperative plan involved a staged approach, beginning with total arch replacement (TAR) using the frozen elephant trunk (FET) technique and coronary artery bypass grafting (CABG), followed by thoracic endovascular aortic repair (TEVAR) and hybrid repair with abdominal debranching. The patient was discharged without complications. Although thoracoabdominal aortic surgery carries a high risk of mortality, it can be performed safely with careful preoperative assessment and the development of an individualized surgical strategy.