Hybrid Repair of a Saccular Aortic Arch Aneurysm Ruptured in the Left Pulmonary Bronchus

The rupture of aortic arch aneurysm is rare but serious and a life-threatening pathologic condition. We report a case of an 80-year-old woman who was admitted to our department for a rupture of a saccular aortic arch aneurysm in the left pulmonary bronchus. There was no landing zone in the aortic arch. First, we performed a total supra-aortic debranching and a bifurcated graft bypass from the ascending aorta to both the innominate artery and the left carotid artery. Then, we implanted in the aortic arch an endoprosthesis covering the origin of all supra-aortic trunks. Final angiography was satisfactory. The patient died 8 days later due to pulmonary-originated septic shock. Aortic arch hybrid procedures show a variety of severe complications associated with a relevant morbidity, mortality, and reintervention rate. Prognosis of rupture depends not only on the hemorrhage caused but also on the potential infection.