Retrograde visceral revascularization using iliac branch stent graft for postdissection thoracoabdominal aortic aneurysm

This case report describes a novel endovascular approach for retrograde visceral revascularization using an inverted iliac branch stent graft in a high-risk patient with a chronic postdissection thoracoabdominal aortic aneurysm. Through an 8.9-mm entry tear in the left common iliac artery communicating with the false lumen, a premanufactured iliac branch stent graft was deployed retrograde to reconstruct the celiac trunk and left renal artery. This technique was combined with physician-modified fenestrated endografting for antegrade superior mesenteric and right renal artery revascularization. Complete aneurysm exclusion and branch preservation were achieved without open surgery, with patency confirmed at the 1-year follow-up. This strategy offers an alternative for anatomy challenging standard fenestrated/branched endografts.