Extrapleural and extraperitoneal staged technique in successful management of complicated thoracic anastomotic aneurysm.

A simplified, staged technique was employed in the management of a descending thoracic aortic pseudoaneurysm occurring in a thoracic aortobifemoral graft that had been placed 10 years earlier. Our initial procedure comprised ligature of the femoral limbs of the functional thoracic aortobifemoral graft together with a right axilloinfrarenal aortobifemoral bypass. This was followed by definitive descending thoracic pseudoaneurysm management 2 weeks later via a thoracoabdominal extrapleural-extraperitoneal approach. This staged approach provided by a preformed shunt, eliminated the disadvantages of heparinization, hemolysis, or trauma of cannulation during the definitive thoracic aneurysmectomy procedure. Ligature and defunctionization of the original thoracic aortofemoral graft simplified the operative dissection, and the extrapleural and extraperitoneal approach minimized postoperative complications.