# Semi-Clamshell Approach with Rib-Cross for Infected Hybrid TEVAR

## TL;DR

A new surgical approach is proposed for removing infected stent grafts in aortic repair, offering better visibility and protection during complex procedures.

## Contribution

The semi-clamshell approach with rib cross is introduced as a viable method for infected hybrid TEVAR explantation.

## Key findings

- The semi-clamshell approach provides clear visualization of the ascending aorta, aortic arch, and descending aorta.
- The method offers reliable cerebral and myocardial protection during infected stent graft removal.
- It is suitable for total arch and distal descending aorta replacement in open conversion of hybrid TEVAR.

## Abstract

A single-stage extensive aortic replacement is necessary for infected stent graft explantation after thoracic endovascular aortic repair (TEVAR). However, establishing selective cerebral perfusion and antegrade myocardial protection while ensuring a clear view of the distal aorta is challenging. We adopted a semi-clamshell approach with rib cross for a case of infection following hybrid TEVAR. This approach provides visualization of the ascending aorta, aortic arch, and the descending aorta down to the diaphragm. It is a viable option for cases requiring total arch and distal descending aorta replacement, offering reliable cerebral and myocardial protection, particularly in open conversion of hybrid TEVAR.