A diagnostic odyssey and successful repair of a progressive aneurysmal expansion after complex aortic surgery and stent grafting of the descending aorta

A 48-year-old patient with Marfan syndrome presented with an ascending aortic and arch periprosthesis hematoma (14.0×9.0 cm) and a descending aortic aneurysm (8.7×9.1 cm) developed over the last 2.5 years, after several operations on the ascending aorta and arch as well as stent-graft placement in the descending aorta. After a diagnostic odyssey, the small true aortic lumen was identified as the source for the ascending aortic periprosthesis hematoma and descending aortic aneurysm expansion. The present case report underlines several important issues in the combined surgical and interventional management of patients requiring multiple and complex procedures on the thoracic aorta.