Extra-anatomic bypass with open-plugging stent graft for extensive dissected aortic aneurysm

Treatment for an extensively dissected aortic aneurysm is a surgical challenge. Open surgery using a left thoracotomy is promising but can be dangerous in patients with pulmonary comorbidity. We treated a 63-year-old man with chronic type B aortic dissection with aneurysmal change and ascending aortic dilation. The thoracoabdominal aorta was also dissected, dilated, and tapered; thus, a simple hybrid strategy was not possible, even with open fenestration. We performed ascending aortic replacement with reconstruction of the cervical vessels and extra-anatomic bypass from the ascending to descending aorta, with aneurysmal isolation. A stent graft was inserted at the true lumen of the residual aneurysm to reduce endopressure. Total thrombosis and reduction in size of the aneurysm was achieved, and the patient recovered well, without complications.