Physician-modified endografts and carotid-subclavian bypass in the treatment of extensive thoracic aortic aneurysm involving the aortic arch.

ObjectivesThoracic aortic aneurysm (TAA) involving the aortic arch poses a significant risk of cerebrovascular accidents and presents technical challenges for repair. This report presents a hybrid approach combining carotid-subclavian bypass (CSbp) and physician-modified endografts (PMEGs) for a patient with extensive aortic arch involvement.MethodA 77-year-old asymptomatic man with a large TAA extending into the aortic arch underwent a hybrid procedure. The intervention included a CSbp and the deployment of a double-fenestrated PMEG, prepared using a Valiant Captivia stent-graft platform, with additional branches to accommodate supra-aortic vessels.ResultsThe patient's intraoperative and postoperative course was uneventful, with no neurological or vascular complications. Follow-up CTA at 1 year showed a patent carotid-subclavian bypass, well-positioned stent grafts, and no evidence of endoleak or graft migration.ConclusionThe combination of carotid-subclavian bypass and PMEGs offers a feasible and effective treatment for complex TAA involving the aortic arch, particularly in high-risk patients unsuitable for open repair or total endovascular approaches.