Pitfalls in the hybrid approach of type B aortic dissection with arch involvement.

Type B aortic dissection (TBAD) with arch involvement is a severe, life-threatening condition. By combining open surgical and endovascular techniques, the hybrid approach has emerged as the preferred treatment option for this challenging disease. The hybrid concept entails reimplantation or bypass of all epiaortic vessels to create an adequate proximal landing zone suitable for thoracic endovascular aortic repair (TEVAR). However, the outcome of patients with TBAD treated with complete surgical debranching in the native ascending aorta and subsequent TEVAR is unsatisfactory, resulting in a mortality rate of 27-70% (1,2). Consequently, the therapeutic management of complicated TBAD by open arch replacement with frozen elephant trunk (FET) placement is becoming the first line treatment in many leading centers for aortic surgery.