Hybrid Arch Repair Including Supra-Aortic Debranching on the Descending Aorta Hideyuki Shimizu, MD, PhD, Takashi Hachiya, MD, Kentaro Yamabe, MD, Ryohei.

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Hybrid Arch Repair Including Supra-Aortic Debranching on the Descending Aorta Hideyuki Shimizu, MD, PhD, Takashi Hachiya, MD, Kentaro Yamabe, MD, Ryohei Yozu, MD, PhD The Annals of Thoracic Surgery Volume 92, Issue 6, Pages 2266-2268 (December 2011) DOI: 10.1016/j.athoracsur.2011.05.045 Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Preoperative computed tomography images. (A) Chronic aortic dissection in the aortic arch. Pectoral muscular flaps appear in the midst of the non-coapted sternum. (B, C) A large irregular protrusion, indicative of a pseudoaneurysm with partial thrombosis, appears at the distal anastomosis of a prosthetic graft in the ascending aorta. There is another prosthesis in the descending aorta. The Annals of Thoracic Surgery 2011 92, 2266-2268DOI: (10.1016/j.athoracsur.2011.05.045) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Computed tomography image obtained after hybrid repair. The supra-arch vessels are connected by a branched prosthetic graft. The left subclavian artery is anastomosed to another graft, which extends from the descending aorta and provides the only inflow for all supra-arch branches. The origin of the brachiocephalic artery was occluded by coils. An endoprosthesis bridges 2 previously implanted prosthetic grafts, from just above the sinotubular junction proximally to the origin of the brachiocephalic bypass. The Annals of Thoracic Surgery 2011 92, 2266-2268DOI: (10.1016/j.athoracsur.2011.05.045) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions