Hybrid repair for a ruptured aortic arch and descending aortic aneurysm in a kidney-transplanted patient]

We present a case of a 53 year old male renal transplanted patient, who presented with severe dyspnea. Chest X-ray and CT angiography showed a left sided haemothorax caused by an aortic arch aneurysm rupture. Acute operation was carried out, an ascendo-anonymo-carotid "Y" bypass was performed from sternotomy and a stent graft implantation through femoral artery. As a second step, the blood clot mass, which caused compression atelectasis of the left lung, was removed by a thoracic surgeon. At follow-up the patient was in good condition, the bypass graft functioned well, the stent graft stayed in good position, the aneurysm sack was reduced and the left lung expanded well.Traditional operation of aortic arch aneurysm carries high mortality and morbidity rate, because of use of extracorporeal perfusion and deep hypothermic circulatory arrest. Hybrid operation became an alternative treatment. After circulation of supra-aortic arteries secured by "debranching procedure", a stent graft implantation is done. Such interventions means less strain for patients, but strict follow up is required, because lack of long-term data. Hybrid reconstruction of the aortic arch aneurysm is rarely performed in acute cases, but means an alternative treatment for high risk patients with acceptable results.