When even luck matters: a compendium of all possible complications during hybrid repair of a dissecting TAAA occurred in a single patient

Purpose. A 73-year-old woman, already submitted to repair of the ascending aorta and subsequently to aortic valve substitution in redo sternotomy, presented to our attention with a dissecting TAAA with a distal aortic arch diameter of 6 cm. Our goal was to offer this extremely fragile patient the least invasive surgical treatment as possible. Technique. We treated this patient in two stages. In the first stage we performed a carotid-carotid-subclavian bypass. In the second stage we performed a TEVAR in zone 1, extending from the brachiocephalic artery to the celiac trunk. Left subclavian artery was previously occluded with a plug. CSFD was not adopted by default. Conclusion. This patient reported some extremely rare and unexpected complications that brought us to report this case. Hybrid techniques represent an extremely appealing opportunity to treat fragile patients affected by complex aortic diseases with relatively little invasive strategies, however, serious complications can occur.