Aortic Rupture During a Staged Endovascular Repair of a Thoracoabdominal Aneurysm

• A staged repair is advocated whenever possible to reduce the risk of paraplegia during extensive TAAA repair.
• Completion of the second stage (fenestrated endografting) should be performed 6–8 weeks after the initial TEVAR procedure.
• If the second stage is delayed, there is a significant risk of interval aneurysm rupture.

IntroductionThe management and outcome of a patient with a type III thoracoabdominal aortic aneurysm (TAAA) are reported.MethodsThe patient was scheduled for a two-stage endovascular repair strategy but experienced a contained TAAA rupture a week before the planned second stage fenestrated endovascular repair that had been postponed from 6 weeks to 5 months.ResultsFortunately, the fenestrated device had already been delivered to the hospital; the contained rupture was thus managed endovascularly in this high-risk patient.ConclusionStaging extensive TAAA repairs to reduce the incidence of spinal cord ischemia is associated with a risk of interval aneurysm rupture.