LAUSR

A 66-year-old man with his Adamkiewicz artery originating from a right-sided distal descending thoracic aorta, suffered a chronic dissecting aneurysm of the entire aorta (Figure 1, Figure 2). Although reconstruction of the Adamkiewicz artery at open surgery was ideal, it was considered to be difficult through a right thoracotomy approach. Therefore, we planned a staged hybrid procedure. Initially, total arch replacement (frozen elephant trunk) was performed via a median sternotomy to secure the proximal landing zone for thoracic endovascular aortic repair. One month later, reno-visceral debranching and graft replacement of the abdominal aortic aneurysm was performed via a midline laparotomy to obtain sufficient distal fixation length for endovascular repair. Finally, the patient underwent endovascular aortic repair under cerebrospinal fluid drainage 10 days later (Figure 1c). Although the Adamkiewicz artery was not reconstructed, spinal cord ischemia did not occur Figure 1. (a, b) Preoperative 3-dimensional computed tomography showing the Adamkiewicz artery originating from the right-sided distal descending thoracic aorta (arrow). (c) Postoperative 3-dimensional computed tomography.