A novel technique of total debranching TEVAR with inflow from the descending aorta.

An 82-year-old male with TAA was considered high risk for conventional surgery because of previous CABG. Therefore, a hybrid repair was performed. First, the arch vessels were debranched extra-anatomical bypass. Second, left thoracotomy was performed. The proximal side of a bifurcated graft was anastomosed to the descending aorta. To arch vessels' debranch graft, two bifurcated graft distal limbs were anastomosed with a 10-mm distance. Two stentgrafts were deployed from the ascending to descending aorta. Postoperative CT did not reveal any endoleak, and all debranch grafts were patent.