Endovascular stent-graft placement in the descending aorta through an ascending aorto-bifemoral bypass.

Purpose: To report a combined conventional and endovascular strategy to treat a descending aorta anastomotic aneurysm.

Case Report: A 60-year-old man with previous obliteration of the infra renal aorta suffered from bilateral lower limb acute ischemia. Lower limb vascularization was provided by a previous thoraco-bifemoral bypass. Computed tomography and angiography revealed an aortic anastomotic false aneurysm and an embolic aspect of the first centimeters of the graft. Treatment combined revascularisation of the lower limbs by an ascending aorta bifemoral bypass through a median sternotomy and endovascular coverage of the false aneurysm by stent-graft placement in the descending aorta. Stent-grafts were introduced through a graft's limb and across the anastomosis in the ascending aorta. Imaging at 3 months revealed no endoleak and perfect patency of the bypass.

Conclusion: This case illustrates how combined endovascular and conventional procedures can minimize surgical risks in complex cases.