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A case of complicated abdominal aortic pseudoaneurysm not suitable for open repair is described. It was treated by means of endovascular methods with a flared endograft limb. The uniqueness of this case is the absence of a suitable femoral access, requiring the deployment of the graft in a reversed configuration through axillary artery.

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Purpose: To describe an endovascular technique for treating a pseudoaneurysm of the thoracic aorta using an off-label "hourglass" stent-graft configuration.

Case Report: A 68-year-old patient with prior open thoracic aorta coarctation repair presented with recurrent coarctation and concurrent enlarging 6-cm bilobed pseudoaneurysm involving the previous anastomosis. There was significant discrepancy in the aortic diameter (measured from wall to wall) proximal to the coarctation (14 mm), at the narrowest segment (8 mm), and distally (23 mm).

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We report a case of a life-threatening internal iliac artery aneurysm rupture managed successfully with an on-table reversed flared iliac limb stentgraft and embolization. This easily off-the-shelf reproducible technique avoids using a more complex and expensive bifurcated aorto-iliac graft and could be a good solution in emergency situation where a custom graft is not available.

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Background: The reoperative risk for degenerated aortic valve xenografts may be increased in elderly patients with comorbidities. We evaluated the off-pump beating heart concept of transapical aortic valve implantation using the valve-in-valve (VinV) concept.

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