Hybrid Repair of Subclavian-Axillary Artery Aneurysms and Aortic Arch Aneurysm in a Patient With Marfan Syndrome Akihiro Yoshitake, MD, PhD, Hideyuki.

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Hybrid Repair of Subclavian-Axillary Artery Aneurysms and Aortic Arch Aneurysm in a Patient With Marfan Syndrome Akihiro Yoshitake, MD, PhD, Hideyuki Shimizu, MD, PhD, Satoshi Kawaguchi, MD, PhD, Takahito Itoh, MD, Hiroyuki Kawajiri, MD, Ryohei Yozu, MD, PhD The Annals of Thoracic Surgery Volume 95, Issue 4, Pages 1441-1443 (April 2013) DOI: 10.1016/j.athoracsur.2012.08.089 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Baseline computed tomographic scan shows a subclavian-axillary artery aneurysm and dilation of the aortic arch. The prosthetic graft that was inserted previously to replace the middle portion of the descending thoracic aorta shows tortuosity. The Annals of Thoracic Surgery 2013 95, 1441-1443DOI: (10.1016/j.athoracsur.2012.08.089) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Diagram of the hybrid repair. The right axillary artery was replaced with a Dacron graft. The entire aortic arch was replaced with a four-branched Dacron graft. An endoprosthesis was placed in a bridging position between the aortic arch graft and the graft in the descending aorta. Another endoprosthesis was placed between the graft that replaced the axillary artery and one branch of the four-branched graft. The Annals of Thoracic Surgery 2013 95, 1441-1443DOI: (10.1016/j.athoracsur.2012.08.089) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Computed tomographic scan obtained after the hybrid repair shows that all bypasses are patent and that the aneurysms are completely excluded from the blood flow. The Annals of Thoracic Surgery 2013 95, 1441-1443DOI: (10.1016/j.athoracsur.2012.08.089) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions