Emergency one-stage hybrid surgery for ruptured aneurysm of the distal aortic arch.

Rupture of an aortic arch aneurysm is a life-threatening condition that requires emergency operation. For rupture of a distal arch aneurysm, we performed--with the patient under total circulatory arrest--an emergency total arch replacement with an elephant-trunk procedure, followed by one-stage antegrade stent-grafting. Prompt institution of cardiopulmonary bypass and total circulatory arrest has the advantage of lessening the risk of overt aortic rupture in this emergency situation.