Aneurysms of the aortic arch and descending aorta are invariably fatal if left to expand, but also represent considerable surgical challenges. The development of endovascular stent grafts in combination with aortic debranching has produced results at least comparable to the more traditional surgical approach, but with considerably less comorbidity. We describe a technique for debranching of the aortic arch without the use of circulatory support, and in doing so creating a landing zone for thoracic endovascular aneurysm repair (TE-VAR). Although this procedure has been described, innovative features of our technique include transection of the left hemisternum to produce excellent surgical exposure, and ligation of the debranched arch vessels to prevent Type II endoleaks following TEVAR. Additionally, by not using mechanical circulatory support, we remove the associated pathophysiological insult, inflammatory response, and coagulopathy that is synonymous with cardiopulmonary bypass. There is also no need for circulatory arrest, with its associated perils.
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