A 68-year-old male presents for surgical repair of a thoracoabdominal aortic aneurysm (TAAA). He has a significant past medical history that includes a type A aortic dissection (TAAD) 12 years ago, for which he underwent a Bentall repair; poorly controlled hypertension; chronic obstructive pulmonary disease (COPD); tobacco use (45 pack-years); and stage III chronic kidney disease (CKD). His postoperative course was complicated by end-organ ischemia, including ischemic colitis and renal failure. Since then, he has been undergoing routine surveillance of his aorta, and computed tomography (CT) now reveals his aortic aneurysm has enlarged to 5.5 cm starting at the innominate artery and extending into the abdominal aorta, proximal to the renal arteries. Chest radiography demonstrates thoracic aortic aneurysmal dilation, without compression of surrounding structures. Transthoracic echocardiogram demonstrates normal left and right ventricular function, trivial aortic insufficiency (AI), and trivial mitral insufficiency. Laboratory studies indicate a hemoglobin of 14.5 g/dL, hematocrit 44%, blood urea nitrogen (BUN) 22 mg/dL, and creatinine 1.8 mg/dL.