Left thoracotomy removal of a fenestrated stent graft and arch/descending aortic replacement for chronic aortic dissection.

A 58-year-old woman with chronic aortic dissection developed rapid aneurysmal enlargement of the distal aortic arch and descending aorta following fenestrated thoracic endovascular aortic repair with left subclavian artery stenting. Computed tomography revealed a proximal type I endoleak associated with progressive aneurysmal dilatation. The patient underwent urgent open surgical repair via a left thoracotomy, including complete removal of the fenestrated stent graft and replacement of the distal aortic arch and descending aorta. The post-operative course was uneventful, and follow-up imaging demonstrated satisfactory graft configuration without any graft-related complications. This case highlights the technical considerations and feasibility of stent-graft removal and open aortic replacement through a left thoracotomy approach after failed fenestrated thoracic endovascular aortic repair.