Native Aorta Non-Touch Total Arch Hybrid Repair for Residual Aortic Dissection after Hemiarch Replacement

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Residual dissecting aortic arch aneurysm after hemiarch replacement for acute type A aortic dissection (n=1). Intervention: Native aorta non-touch total arch hybrid repair (total supra-aortic debranching and short elephant trunk placement via existing hemiarch graft followed by staged TEVAR). Primary outcome: Freedom from endoleak and aortic events at 5-year follow-up.

Kazuma Handa; Tomohiko Sakamoto; Toshihiro Ohata; Teruya Nakamura; Toru Kuratani

doi:10.3400/avd.cr.26-00112

January 1, 2026Annals of Vascular DiseasesOpen Access

Native Aorta Non-Touch Total Arch Hybrid Repair for Residual Aortic Dissection after Hemiarch Replacement

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Key result

Hybrid arch repair with staged TEVAR achieves zero endoleaks or aortic events at 5 years.

n=1

Why the study?

Is native aorta non-touch total arch hybrid repair followed by staged TEVAR feasible and safe for managing residual dissecting aortic arch aneurysm after prior hemiarch replacement?

Key Points

To describe the feasibility of a native aorta non-touch total arch hybrid repair for progressive residual dissecting arch aneurysm following hemiarch replacement.
A 70-year-old man presented with progressive dissecting arch aneurysm dilatation to 55 mm 6 years after initial hemiarch replacement for acute type A aortic dissection.
Total supra-aortic debranching and a short elephant trunk (26 mm–4 cm) were placed directly into the existing hemiarch graft under circulatory arrest, avoiding manipulation of the fragile native aorta.
Staged thoracic endovascular aortic repair using a conformable graft (37 mm–20 cm) was performed the following day to seal the descending aorta.
Postoperative computed tomography confirmed complete absence of endoleak or stent graft-induced new entry, alongside patent supra-aortic branch reconstructions.
The patient remained alive and free from aortic events across 5 years of postoperative follow-up.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Is native aorta non-touch total arch hybrid repair followed by staged TEVAR feasible and safe for managing residual dissecting aortic arch aneurysm after prior hemiarch replacement?

P

Population

1 male patient (aged 70 years) in Japan with a 55 mm residual dissecting aortic arch aneurysm 6 years after hemiarch replacement for acute type A aortic dissection, followed for 5 years.

I

Intervention

Native aorta non-touch total arch hybrid repair using the previously implanted hemiarch graft as the inflow source for total supra-aortic debranching (J-graft debranch graft 11-9-9 mm and 9 mm x 2) and short elephant trunk (J-graft 26 mm-4 cm) placement, followed by staged thoracic endovascular aortic repair (TEVAR) the following day using a conformable GORE TAG (CTAG 37 mm-20 cm)

O

Outcome

Freedom from endoleak, stent graft-induced new entry, and aortic events at 5-year follow-uphard clinical

Native aorta non-touch total arch hybrid repair utilizing a previously implanted hemiarch graft for debranching and short elephant trunk placement followed by staged TEVAR is a feasible option for selected high-risk patients with residual dissecting arch aneurysm.

Limitations

Single-patient case report
Diseased native aorta is not resected, carrying potential long-term risks of proximal leakage, endoleak through collateral arteries, aortic reintervention, and branch graft stenosis or occlusion
Requires long-term CT surveillance for endoleak, residual aortic disease progression, and supra-aortic branch graft patency
Because the diseased native aorta is not resected, the procedure is less radical and carries potential long-term risks of proximal leakage, endoleak through intercostal or other collateral arteries, aortic reintervention, and stenosis or occlusion of the supra-aortic branch grafts.
Long-term CT surveillance for endoleak, residual aortic disease, and supra-aortic branch graft patency remains essential.

Ask about this paper

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Implication

Should not yet change redo arch practice; leaves open durability of non-touch hybrid repair in larger cohorts.

Abstract

Reintervention for residual aortic arch dissection after hemiarch replacement for acute type A aortic dissection remains technically challenging. A 70-year-old man presented with progressive dissecting arch aneurysmal dilatation 6 years after hemiarch replacement. Native aorta non-touch total arch hybrid repair was performed using the previously implanted hemiarch graft as the inflow source for total supra-aortic debranching and as the site for short elephant trunk placement. Staged thoracic endovascular aortic repair was performed the following day. Postoperative computed tomography showed no endoleak, and the patient remained free from aortic events at 5-year follow-up.

Discussion

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Cite This Study

Handa et al. (2026) conducted a case report in Residual dissecting aortic arch aneurysm after hemiarch replacement for acute type A aortic dissection (n=1). Native aorta non-touch total arch hybrid repair (total supra-aortic debranching and short elephant trunk placement via existing hemiarch graft followed by staged TEVAR) was evaluated on Freedom from endoleak and aortic events at 5-year follow-up. Native aorta non-touch total arch hybrid repair with staged TEVAR resulted in no endoleak and complete freedom from aortic events at 5-year follow-up in a 70-year-old man.

synapsesocial.com/papers/6af347b7bdf2424ebd04f8b5 https://doi.org/10.3400/avd.cr.26-00112

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Native Aorta Non-Touch Total Arch Hybrid Repair for Residual Aortic Dissection after Hemiarch Replacement

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Native Aorta Non-Touch Total Arch Hybrid Repair for Residual Aortic Dissection after Hemiarch Replacement

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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