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The surgical repair of thoracoabdominal aortic aneurysm (TAAA) remains one of the most technically demanding surgical procedures in vascular surgery. High-volume centers still have significant morbidity and mortality rates of 12%–15%. Emergence of thoracic endovascular aneurysm repair (TEVAR) improved these figures but was limited by the availability of customized grafts and cost factors. An effective alternative approach hence is a hybrid procedure that involves the combination of open technique for debranching of viscerorenal aorta and use of standard TEVAR stent graft to cover aneurysmal segment. We report a case of an elderly male who underwent a successful staged Hybrid TEVAR procedure for Type 3 equivalent TAAA.

Acute suprarenal aortic occlusion, though rarely reported carries a high morbidity and mortality. Renal ischemia is one of the usual presenting features. Limb salvage and renal preservation depend on prompt diagnosis and management. A young patient with acute suprarenal aortic occlusion having renal failure and limb ischemia was managed with suprarenal thrombectomy and aortobifemoral bypass at our centre. Even though the presentation was delayed, renal functions were restored post procedure. This case highlights that renal revascularisation can be attempted in select cases with delayed presentation.

Primary inferior vena cava (IVC) tumors are rare with the incidence of about 0.05% overall with leiomyosarcoma (LMS) being malignant and the most common. They are late to present and slow growing, seen predominantly in females in their fifth or sixth decades and have a poor prognosis with a 5-year survival rate touching about 35% even with complete surgical resection. We present our experience with two patients diagnosed to have IVC LMS and underwent complete surgical resection of the tumor with reconstruction of IVC using coated polyester graft. In one patient, only infrarenal IVC was reconstructed, whereas in second patient, bilateral renal veins were also reconstructed along with suprarenal IVC. There is no consensus regarding the optimal treatment of this aggressive tumor, but complete excision of the tumor with wide margins with or without IVC reconstruction have been widely accepted as primary modality of treatment. Neoadjuvant or adjuvant chemoradiotherapy have limited role in the management of this rare tumor.