複雑な大動脈弓病変に対する簡略化された戦略：1型ハイブリッド弓部再建術

We report a case of a large distal arch and proximal descending thoracic aortic saccular aneurysm managed successfully with type I hybrid arch repair (off-pump debranching + thoracic endovascular aortic repair). Conventional open total arch replacement involves significant peri-operative risks, especially in elderly or comorbid patients, due to the need for cardiopulmonary bypass, circulatory arrest and cerebral protection. The hybrid arch repair technique combines open debranching of supra-aortic vessels with endovascular stent grafting to exclude the aneurysmal segment. This method avoids circulatory arrest, reduces operative time and minimizes complications, while maintaining the durability of open repair. It is particularly suitable for aneurysms of the distal arch and proximal descending thoracic aorta, with an adequate ascending aortic landing zone for endograft deployment.