Page 24 - Virtual Vascular Vol 11

In view of his advanced age open total arch repair is out of the question. The ascending aorta is
too dilated and diseased to make a good landing zone for any endograft. Technically a less in-
vasive option would be a sternotomy and replacement of the ascending aorta with a prosthetic
graft, with prosthetic bypasses to the innominate and L common carotid artery as a “hybrid, de-

branching” operation. Followed by a TEVAR. This is still an operation of some magnitude requir-
ing cardiopulmonary bypass and is unlikely to be feasible.

Without treatment (or conservative treatment) it is likely that this aneurysm will grow and eventu-
ally rupture in view of its morphology.

24