Parallel endograft repair of an aortic anastomotic pseudoaneurysm in a patient with middle aortic syndrome.

A 66-year-old female, with a history of middle aortic syndrome, who had been treated with aorto-iliac bypass, presented 47 years later with a pseudoaneurysm at the distal anastomosis. She was treated with parallel grafting and preservation of a large lumbar artery via periscope approach. This case highlights the challenges and considerations in managing aortic anastomotic pseudoaneurysms, particularly in patients with complex surgical histories with extra-anatomic debranching bypasses.