title: Reversed sequence arch debranching for treatment of a ruptured juxta-innominate artery saccular aneurysm.
abstract: OBJECTIVE
  To describe a hybrid approach for the treatment of a ruptured juxta-innominate artery saccular aneurysm.
  
  
  METHODS
  A 68-year-old smoker male with poor exercise tolerance sustained a contained ruptured saccular aneurysm at the origin of the innominate artery. Although under the femoral-axillary bypass to allow direct brain perfusion, a 36 × 110 mm thoracic endograft was successfully deployed with total coverage of the distal ascending and aortic arch. A sternotomy was performed and an aorto-innominate and left common carotid artery bypass was done. At 1-month follow-up, a type 2 endoleak at the innominate artery stump was noted and successfully treated with coil embolization. The patient remains neurologically intact 1 year after the surgery.
  
  
  CONCLUSIONS
  Juxta-innominate artery saccular aneurysms are rare. A hybrid open-endovascular repair using a reversed sequence arch debranching after endovascular repair is feasible and may be an alternative to deep hypothermic circulatory arrest particularly in frail patients.
authors.affiliation: Division of Vascular Surgery, Stony Brook Medical Center, Stony Brook, NY 11794, USA. rafael.malgor@stonybrook.edu
authors.forename: Rafael D
authors.initials: RD
authors.lastname: Malgor
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Bilfinger
authors.forename: Apostolos K
authors.initials: AK
authors.lastname: Tassiopoulos
mesh_terms: D000368:Aged; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D016122:Brachiocephalic Trunk / Q000000981:diagnostic imaging / Q000601:surgery*; D004621:Embolization, Therapeutic; D057867:Endoleak / Q000209:etiology / Q000628:therapy; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome