# Thoracic Endovascular Aortic Repair with Reverse Aortic Arch Debranching Technique for Ascending Aortic Pseudoaneurysm

## TL;DR

A high-risk patient with an aortic pseudoaneurysm was successfully treated with a hybrid endovascular technique, avoiding open surgery.

## Contribution

Demonstrates a novel hybrid approach for treating ascending aortic pseudoaneurysms in patients unsuitable for open surgery.

## Key findings

- Thoracic endovascular repair with reverse aortic arch debranching was successfully applied in a high-risk patient.
- The patient recovered well and proceeded to cancer treatment without complications.
- This case supports hybrid strategies as a feasible alternative to open repair for aortic pseudoaneurysms.

## Abstract

Ascending aortic pseudoaneurysm is a rare but life-threatening complication after cardiac surgery, typically requiring redo open repair with substantial risk. We report a 58-year-old male with an incidental 85-mm ascending pseudoaneurysm discovered during evaluation for recurrent hepatocellular carcinoma. Due to prior sternotomy, cirrhosis, and urgent oncologic need, open surgery was deemed prohibitive. He successfully underwent thoracic endovascular repair with reverse extra-anatomical aortic arch debranching technique. He recovered uneventfully and proceeded to cancer treatment without delay. This case highlights the feasibility of hybrid endovascular strategies for ascending aortic pathology in high-risk patients.