Concomitant thoracoabdominal aneurysm and aortoiliac occlusion are extremely rare and present a unique surgical challenge. We report the successful reconstruction of a 9.2-cm extent III thoracoabdominal aneurysm and aortoiliac occlusion in a 54-year-old male. The surgery was performed using a trifurcated graft and total cardiopulmonary bypass. The combination of cerebrospinal fluid drainage, cold renovisceral perfusion, and reattachment of large segmental arteries resulted in a successful outcome in this rare presentation.
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