A bilobed syphilitic thoracoabdominal aortic aneurysm with vertebral erosion and multibranch visceral occlusion.

A 55-year-old man with serologically confirmed tertiary syphilis had an asymptomatic 70 mm bilobed thoracoabdominal aortic aneurysm with two contiguous saccular components, severe T11 to T12 vertebral body erosion, complete celiac artery occlusion, and critical ostial stenosis of the superior mesenteric and right renal arteries, with mature collateral perfusion from the inferior mesenteric artery. After preoperative penicillin therapy, open repair with selective left renal artery reimplantation and intentional nonreconstruction of the chronically occluded visceral branches was completed without paraplegia or mesenteric ischemia.