Thoracic endovascular aortic repair-first hybrid repair without thoracotomy for type V thoracoabdominal aortic aneurysm

We report a case of type V thoracoabdominal aortic aneurysm treated using two-stage hybrid repair. A 47-year-old man had a history of left nephrectomy for hydronephrosis in early childhood, Takayasu arteritis, and total arch replacement for ascending aortic aneurysm. He first underwent zone 4 thoracic endovascular aortic repair, followed by open surgery for the thoracoabdominal aortic aneurysm without thoracotomy. The previously deployed stent graft served as the proximal clamping site, enabling the proximal anastomosis to be performed below the diaphragm. This hybrid approach enabled surgical repair without thoracoabdominal incision or diaphragmotomy, which are known to cause short- and long-term side effects.