Aortectomy and axillary-bifemoral bypass
This patient had a previous EVAR which got infected and subsequently got explanted along with the native distal aorta.
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There is normal mediastinal vascular enhancement and aorta branching
pattern. Normal aortic arch and descending aorta. Stump with surgical clips demonstrated at the L1-L2 level, similar to previous. Patent coeliac and superior mesenteric arteries. No opacification of the inferior mesenteric artery. Reconstitution of the pelvic vasculature from the distal aspects of the common iliac arteries with patency to the external and internal arteries.
Left external iliac graft runs through the anterior abdominal soft tissues and joins a graft from the right common femoral artery within the right side of the abdominal subcutaneous tissues, travelling superiorly to eventually joining to the right subclavian artery. Graft and arteries are patent. No contrast extravasation. No evidence for anastomotic stenosis.
There is nothing wrong with the graft; it is just an example of some serious plumbing.