Parallel Intercostal Artery Stenting and Exclusion of Symptomatic Bucket-Handle Intercostal Patch Aneurysm

Intercostal patch aneurysms after open thoracoabdominal aneurysm repair represent a challenging pathology with highly variable patient anatomy and spinal cord ischemia risk. We present a case of a 51-year-old man with a large symptomatic “bucket-handle” loop graft intercostal patch aneurysm which was treated with endovascular exclusion with concurrent parallel intercostal stent grafting. This case highlights specialized endovascular techniques to treat intercostal patch aneurysms and the necessity of meticulous operative case planning in both open and endovascular thoracoabdominal aneurysm repair.