Vascular plug oversizing to treat an endoleak after hybrid surgery of the aortic arch

Abstract A patient with prior ascending aortic replacement for a type A acute dissection and a bovine arch presented with an asymptomatic chronic dissecting innominate artery aneurysm extending to both carotid arteries. As the patient refused redo open surgery, we performed a hybrid procedure with reverse extra-anatomic aortic arch debranching and a fenestrated endograft. The aneurysm was still partially perfused due to an endoleak and corrected 1 week later with vascular plugs. Aneurysmal degeneration of a dissected supra-aortic vessel requiring surgical intervention is not a frequently reported topic in literature [1].