Current results of open surgical repair of descending thoracic aortic aneurysms

Open thoracic aneurysm repair accomplished with left heart bypass via left atrial cannula and femoral inflow (preferred approach at Johns Hopkins Hospital). This approach entails posterolateral thoracotomy to achieve surgical exposure. Clamp-and-sew is also a viable alternative if lesion extent or complexity is moderate. (Reprinted from Willams GM and Schlossberg L. Atlas of aortic surgery. Baltimore, Md: Williams and Wilkins, 1997.)

Angiogram of completed “hybrid.” Bypass grafts are evident to left renal artery and superior mesenteric artery via a single limb and separate limb to hepatic and right renal arteries. (Courtesy Patrick Geraghty, Washington University School of Medicine.)

Computed tomography angiography of completed “debranching” of the aortic arch to facilitate stent-graft repair of distal arch aneurysm.