Open Conversion After Branched Endovascular Aortic Repair With a Novel Hybrid Graft

Open surgical conversion (OSC) constitutes the final treatment option for failed endovascular aortic repair. The procedure is exceptionally challenging and infrequently performed, particularly following complex aortic reconstructions involving the thoracoabdominal segment. We describe a unique technique of an OSC for thoracoabdominal aneurysm due to persistent endoleak after branched endovascular aortic repair and multiple endovascular endoleak treatment attempts, which was accomplished using a novel Thoracoflo hybrid device.Clinical ImpactThis technical note introduces the first open surgical conversion after a failed branched endovascular repair of a thoracoabdominal aortic aneurysm, using the new hybrid Thoracoflo device. This innovative technique reduces reno-visceral ischemia time and can be performed through a xipho-pubic laparotomy without the need for extracorporeal circulation. It offers a safe and effective solution for complex thoracoabdominal aortic diseases, and can also serve as a bailout option following endovascular failure.