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this video demonstrates endovascular repair of ascending iotic secular aneurysm in a 78 year old female who presented with a 4.1 centimeter ascending iotic aneurysm thought to be secondary to penetrating iot calcium she complained of chest pain on arrival and has an active diagnosis of pancreatic cancer she was deemed a poor open surgical candidate ct angiogram of the chest demonstrated a 4.1 centimeter ascending aortic secular aneurysm this was secondary to a penetrating iotic ulcer demonstrated here is this ascending iotic circular aneurysm we begin our procedure by gaining access to the right internal jugular vein using a mini stick needle wire and micropuncture sheath we then upsize to a seven french sheath and introduce a temporary pacemaker wire in the right ventricle and this was connected for rapid ventricular placing next the left common femoral artery was excess under ultrasound guidance using a mini stick needle followed by the wire and micropuncture sheath he then upsized t