Simultaneous Repair of Pseudo Para-Anastomotic Aneurysm and Abdominal Aortic Aneurysm With Hybrid Approach.

Para-anastomotic aneurysm (PAA) is a rare and severe complication after open surgery for aortic aneurysm or occlusive disease. A 65-year-old man with a history of left common iliac-femoral artery bypass surgeries for occlusive disease 15 years ago presented with a femoral pseudo PAA and AAA. Endovascular repair and surgical clamping of the proximal artery of the pseudo PAA were considered technically challenging due to complex anatomy and severe adhesions. We used an occlusion balloon to control bleeding from the pseudo PAA and performed surgical repair of the pseudo PAA and AAA simultaneously. Simultaneous repair of pseudo PAA and AAA with a hybrid approach is extremely rare. Although the number of endovascular aneurysm repair cases has increased, some cases, like this one, still require open surgery.