Hybrid arch repair including supra-aortic debranching on the descending aorta

A 49-year-old patient with an anastomotic pseudoaneurysm in the aortic arch was considered at high risk for conventional surgery through a median sternotomy because he had previously undergone several operations to treat aortic dissection and had a deep sternal infection after one procedure. Therefore, a hybrid repair was performed. Stent grafts were placed bridging two previously implanted aortic prostheses, which were in the ascending aorta and descending aorta, respectively. The supra-arch vessels were perfused by means of an extra-anatomic bypass from the descending aorta. The aneurysm was completely excluded from the blood flow, and the patient had no serious complications.