Repair of a ductal aneurysm using a hemi-clamshell incision in an elderly patient

Spontaneous ductal aneurysm is rare in adults, although it is diagnosed sporadically, even in the elderly. Commonly, patients with a ductal aneurysm undergo an aneurysmectomy followed by patch-plasty through a lateral thoracotomy. However in older patients, more extensive surgery is often required due to more developed atherosclerotic lesions, requiring total arch replacement. Here, we describe the repair of a ductal aneurysm through a hemi-clamshell incision in an elderly patient. This method enabled excellent exposure of the entire aneurysm and, most importantly, adaptability in performing either an aneurysmectomy followed by patch closure, or total aortic arch replacement, dependent on the extent of the atherosclerotic disease once surgically exposed.