Replacement of an artificial graft in a redo lateral thoracotomy is extremely difficult with a high risk of lung injury. Endovascular intervention may be an ideal option in such conditions, as in the following case. A 75-year old man with a history of coronary artery bypass graft surgery developed a proximal anastomotic pseudoaneurysm 1 year after undergoing artificial proximal descending aorta replacement surgery. Thoracic endovascular aneurysm repair was performed successfully using the periscope graft technique to preserve the flow into the left subclavian artery from the distal side of the aortic stent graft. Since the patient had coronary artery bypass grafting, debranching of the left subclavian artery was considered too risky. Using the periscope graft technique, the pseudoaneurysm was successfully repaired preserving the left subclavian artery patency, thus obviating a side-to-side subclavian artery crossover bypass.
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