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case_images: CT aortography. 3D reconstructed image showed extensive (type II) thoracoabdominal aortic aneurysm extending from the left subclavian artery to the infrarenal aorta. Aortic arch branches were normal.
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case_images: There were two saccular aneurysms:one in the descending thoracic aorta measuring 3.4 cm x 3 cm and another in the abdominal aorta of size 6.2 cm x 4.2 cm (Figure 1). The right renal artery was completely occluded.
case_images: Endovascular aneurysm repair. The thoracic aortic stent graft was deployed first. The SMA stent was placed through the implanted graft. The stent in the left renal artery was placed from the left femoral artery, and the second aortic stent graft was positioned from the right femoral artery.
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case_images: The first and second aortic graft overlap was 6 to 7 cm (Figure 2). TAA stent graft, Lifetech Scientific, Shenzhen, China) distally (Figure 4, Supplementary material online, video  S2). The left renal stent was reinforced by deployment of a 6 * 27 mm stent (Visi-pro , Medtronic Inc., USA). The post-procedure aortogram confirmed the exclusion of the aneurysm and patent flow in SMA and left renal arteries.
case_images: Follow-up CT. CT after two years showed contrast enhancement in the abdominal aortic saccular aneurysm and enlargement of the aneurysm.
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case_images: At two two-year follow-ups, CT-angiography revealed enlargement of the saccular aneurysm in the abdominal aorta due to type IB endoleak (Figure 3).
case_images: Endoleak repair. Type IB endoleak was treated by placement of a third aortic stent graft distally.
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case_images: TAA stent graft, Lifetech Scientific, Shenzhen, China) distally (Figure 4, Supplementary material online, video  S2). The left renal stent was reinforced by deployment of a 6 * 27 mm stent (Visi-pro , Medtronic Inc., USA). The post-procedure aortogram confirmed the exclusion of the aneurysm and patent flow in SMA and left renal arteries.
case_images: Follow-up CT. Complete obliteration of the saccular aneurysm in the abdominal aorta.
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case_images: Follow-up CT shows complete exclusion of the aneurysmal segments (Figure 5).
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case_images: 3D reconstructed images show a thoracoabdominal aortic aneurysm extending from the distal to the left subclavian artery up to the infrarenal aorta.
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case_images: Computerized tomography angiography revealed an aneurysm involving the descending thoracic and abdominal aorta extending from D4 (dorsal) to L4 (lumbar) vertebral bodies (Figure 6).
case_images: Stenosis of visceral arteries. Severe stenosis of the ostium of the superior mesenteric artery, coeliac artery, and left renal artery. The right renal artery was completely occluded.
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case_images: Severe stenoses were noted at the origin of the coeliac trunk, SMA, and bilateral renal arteries (right > left) (Figure 7).
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case_images: 3D reconstructed images showing extensive thoracoabdominal aortic aneurysm extending from the left subclavian artery up to the aortic bifurcation. Stenosis of ostia of superior mesenteric, coeliac artery ostia, and left renal artery. The right renal artery was completely occluded.
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case_images: Severe ostial stenosis of the SMA, both renal arteries, coeliac artery, and left common carotid artery (Figure 8) was observed.