Thoracic wall ischemia after repair of thoracoabdominal aortic aneurysm requiring large microvascular soft tissue reconstruction

A 67-year-old man presented to the vascular service with a Crawford extent I thoracoabdominal aortic aneurysm. He underwent open thoracoabdominal aortic replacement from just distal to the left subclavian artery to just proximal to the origin of the superior mesenteric artery under deep hypothermic circulatory arrest. His postoperative course was complicated by thoracic wall ischemia, resulting in a life-threatening defect of the chest wall that exposed lung parenchyma and the aortic graft. Successful microvascular soft tissue reconstruction was performed using an anterolateral thigh flap and arteriovenous loop. This is a case report of a large chest wall defect resulting from thoracoabdominal aortic aneurysm repair. This case highlights the feasibility of microvascular reconstruction techniques to repair even the largest defects.