Recent advances in hybrid techniques of aortic arch debranching allow for the repair of thoracic aortic arch aneurysm without requiring cardiopulmonary bypass or hypothermic circulatory arrest. We describe the repair of a ruptured proximal descending thoracic aortic aneurysm, using off-pump aortic arch debranching and antegrade transaortic deployment of a thoracic endograft in an elderly patient.
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