Successful staged repair of arch and descending thoracic aortic aneurysms with conventional elephant trunk and TEVAR

BACKGROUND: Thoracic aortic aneurysms (TAA) involving both the arch and descending aorta present significant surgical challenges. Hybrid approaches combining open repair with thoracic endovascular aortic repair (TEVAR) are increasingly adopted for complex cases. CASE PRESENTATION: We report the case of a 64-year-old male with hypertension, dyslipidemia, and COPD, who presented with dyspnea and cough. Imaging revealed large aneurysms of the aortic arch (8 × 9 cm) and descending thoracic aorta (10 × 9 cm), both layered with thrombus. The patient underwent a staged procedure: (1) total arch replacement with elephant trunk, and (2) TEVAR for the descending thoracic aneurysm. Postoperatively, the patient developed seizures and respiratory complications requiring tracheostomy, but subsequently stabilized. CT angiography confirmed successful graft placement with no endoleak, although a small residual iliac artery aneurysm and venous thrombosis were noted. CONCLUSION: A staged hybrid approach combining elephant trunk and TEVAR provides an effective treatment strategy for extensive thoracic aortic aneurysms, especially in high-risk patients.