A 57-year-old male, previously treated surgically with insertion of grafts for type A and B aortic dissection, presented with a pulsatile mass in the jugular fossa. Further examination verified a pseudoaneurysm the inlet of which was located at the proximal anastomotic site of the descending aortic graft and a newly developed aneurysm of the aortic arch. Using a left lateral thoracotomy to avoid manipulation of the pseudoaneurysm, we adopted a hybrid approach by first debranching the subclavian and carotid arteries from the descending aorta followed by endoluminal grafting of the aortic arch. The pseudoaneurysm was successfully excluded.
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