1. Hybrid Repair of Ruptured Arch Aneurysm Without Sternotomy Through an Unusual Extraanatomic Bypass 
Chung-Lin Tsai, MD, Chih-Chun Yang, MD, Takuya Fujikawa, MD, Shih-Rong Hsieh, MD, PhD 
The Annals of Thoracic Surgery 
Volume 103, Issue 2, Pages e209-e211 (February 2017)
DOI: /j.athoracsur
Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
(A) Sagittal view. (B) Coronal view. Preoperative computed tomographic aortographic views showing a 7-cm aortic arch in B (white arrow), a 6-cm descending aortic aneurysm with anterior rupture in A (black arrow), and a mediastinal hematoma.
The Annals of Thoracic Surgery  , e209-e211DOI: ( /j.athoracsur )
Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
(A) Anastomosis of one 24-mm × 12-mm × 12-mm bifurcated gelatin-sealed polyester vascular graft to the abdominal aortic true lumen. (B) Then, anastomosis of two 12-mm polyester vascular grafts to each of the previous 12-mm limbs of the bifurcated graft and extended to the neck through a subcutaneous tunnel created through the chest wall; insertion of a 16-mm Endurant II endoprosthesis into both 12-mm vascular grafts for reinforcement. (C) Anastomosis of another two bifurcated 16-mm × 8-mm × 8-mm vascular grafts to both carotid arteries and subclavian arteries. (D) Finally, implantation of Gore TAG endoprostheses measuring 37 mm × 20 cm, 37 mm × 15 cm, and 31 mm × 10 cm within the previous replaced ascending aortic graft.
The Annals of Thoracic Surgery  , e209-e211DOI: ( /j.athoracsur )
Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
Computed tomographic angiogram 3 months after the procedure, showing effective exclusion of the ruptured arch aneurysm and patency of all bypass grafts.
The Annals of Thoracic Surgery  , e209-e211DOI: ( /j.athoracsur )
Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions