Paravisceral inflammatory aortic pseudoaneurysms treated with hepatorenal bypass and parallel grafts

Abstract

Aortitis is an over-arching term used to describe inflammation of the aortic wall. It can lead to serious complications such as aneurysm formation, dissection and aortic rupture. Due to its rarity and variability of presentation, diagnosis and management can be challenging. We present a case of a patient who presented with inflammatory aortitis of the paravisceral aorta with pseudoaneurysm formation and proximal superior mesenteric artery thrombosis resulting in acute on chronic mesenteric ischemia. Complex operative fixation using two chimney grafts and one periscope graft, combined with hepatorenal bypass successfully excluded the pseudoaneurysms. The inflammatory aortitis resolved with a short course of high dose steroids. This report highlights the role of hybrid open and endovascular techniques to treat challenging aortic pathology.

Keywords

• Aortitis
• Paravisceral pseudoaneurysm