Re-hybrid thoracic stent graft implantation with total aortic arch debranching in urgent procedure: case report

INTRODUCTION: Implementation of emergency endovascular aortic repair provides an opportunity to treat complicated acute aortic syndromes involving descending aorta. CASE REPORT: A 40-year-old man with a history of aortic coarctation surgical repair as a child and an anastomosis aneurysm repair with a double endovascular stent graft implantation with hemi-arch transposition was urgently admitted with intensifying shortness of breath and hoarseness. A computed tomography study confirmed a blood leak into an aneurysm sac in proximal landing zones of implanted stent grafts (Type I endoleak). Therefore, he qualified for hybrid surgery. First, the ascending aorta brachiocephalic trunk was anastomosed with a 12 mm vascular prosthesis from an upper mini-sternotomy. In the next step, normothermic extracorporeal circulation was necessary to prevent cerebral circulation. Finally, a GORE stent graft (Gore Medical, Flagstaff, AZ, USA) was implanted with a proximal landing zone directly behind the anastomosis site of the vascular prosthesis and ascending aorta. The hospital course was uncomplicated, and the patient was discharged home 5 days after the procedure. CONCLUSIONS: Complicated aortic pathologies requiring emergent interventions can be treated by a hybrid approach utilizing multistep surgical and endovascular techniques achieving optimal results.