[Hybrid Aortic Arch Debranching for Challenging Access Following Abdominal Aorta Resection:Report of a Case]

Eight years previously, a 76-year-old man underwent an open surgical repair of an infectious abdominal aortic aneurysm through a median laparotomy. The abdominal aorta was resected, and blood flow to the lower extremities was reconstructed using an extra-anatomical bypass from the right axillary artery to the bilateral femoral arteries. A computed tomography (CT) scan revealed a distal aortic arch aneurysm just below the left subclavian artery, with a maximum diameter of 58 mm. Given the high-risk nature of an open surgery, we opted for an endovascular intervention. However, accessing the aneurysm from the iliac and femoral arteries was challenging. Therefore, we accessed the ascending aorta after total debranching. A median sternotomy was performed under general anesthesia. Total debranching of the supra-aortic vessels was accomplished without cardiopulmonary bypass by using a side clamp on the ascending aorta. After total debranching, Gore TAG grafts were positioned from zone 0 to Th10. The postoperative course was uneventful, without any complications, and the postoperative enhanced CT revealed no endoleaks.