Successful open repair of syphilitic thoracoabdominal aneurysm

Most syphilitic aneurysms involve the ascending aorta. Those involving the descending aorta are less common, and those involving the abdominal aorta are unusual. Rarer yet, we present the case of a 40-year-old man with HIV and a history of syphilis with a thoracoabdominal aneurysm. The patient underwent antiretroviral therapy before elective open repair. His postoperative course was uneventful, and he was discharged home. Pathology demonstrated medial necrosis. Postoperatively, he was seen well in our multidisciplinary aorta center clinic. Today's vascular surgeons should be cognizant of cardiovascular syphilis. Successful care requires awareness of atypical presentations in addition to multispecialty care. (J Vasc Surg Cases Innov Tech 2024;10:101567.)