Hybrid approach to complex thoracic aortic aneurysms in high-risk patients: Surgical challenges and clinical outcomes

A, Schematic drawing showing a 10-mm limb being sutured to a 14-mm trunk. The 10-mm limb is tunneled superiorly to revascularize the supra-aortic trunks, whereas the 14-mm trunk is used as the conduit for antegrade stent-graft placement. The 14-mm stump is oversewn after completion of the stent-graft deployment. B, Schematic demonstration of an arch aneurysm involving the supra-aortic trunks. The descending aorta is used as the inflow source for supra-aortic trunk debranching procedures. A 10-mm limb is sutured to a 14-mm trunk and tunneled superiorly to revascularize the supra-aortic trunks, whereas the 14-mm trunk is used as the conduit for stent-graft placement. A 24F guiding sheath is inserted into the 14-mm trunk over a wire along with a 5F short guiding sheath for contrast administration. C, Completion angiogram showing aneurysmal exclusion without endoleak and patent carotid-carotid and carotid-subclavian bypass grafts.

Schematic demonstration of an aortic aneurysm involving visceral branches. Visceral vessel debranching procedures, including iliac to celiac and superior mesenteric artery bypasses and iliac to bilateral renal artery bypasses, were performed to render the endovascular treatment a feasible option.