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Failure to exclude a saccular arch aneurysm during hybrid repair: arch replacement without cerebral circulatory arrest

University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2TH, UK

*Corresponding author. Tel.: +44 121 627 2543; fax: +44 121 627 2542.

E-mail address: robert.bonser{at}uhb.nhs.uk (R.S. Bonser).

Thoracic endovascular aortic reconstruction (TEVAR) is increasingly used in the management of descending aortic pathology including aneurysms, dissections and transaction. When treating aortic arch pathology, hybrid procedures have been devised, in which major supra-aortic arteries are translocated using a variety of techniques. Such hybrid procedures offer an attractive alternative to open arch procedures in frail elderly patients in whom the risks of open repair are considerable. We describe a surgical bail-out procedure which was used during a hybrid aortic arch replacement when endovascular aneurysm exclusion could not be achieved.

Key Words: Aorta; Aneurysm; Endovascular repair; Hybrid