Abstract
A 68-year-old female with extensive medical and surgical history, including open and endovascular procedures, presented with chronic limb-threatening ischemia, hypertension, and chronic mesenteric ischemia. A computed tomographic angiogram showed significant paravisceral aortic atherosclerosis involving the celiac, superior mesenteric, and renal arteries. She underwent an open descending aorta to superior mesenteric artery, left renal artery, and left common femoral artery bypass with a "trifurcated" ringed polytetrafluoroethylene graft. Nine months after surgery, she was progressing with significant improvement of her symptoms. Open surgical approaches in aortoiliac disease are reserved for patients with unfavorable anatomy or previous failed endovascular attempts. Detailed preoperative planning and careful patient selection are imperative for optimal outcomes.