Combined Stroke and Spinal Cord Infarction in Hybrid Type I Aortic Arch Debranching and TEVAR and the Dual Role of the Left Subclavian Artery.

AORTIC ARCH pathology, as a part of acute aortic syndrome, is a difficult clinical problem to address. Whether it presents as an intramural hematoma with impending rupture, isolated aneurysmal disease, or acute localized dissection, it creates a clinical challenge to the perioperative team. Some of the difficulty stems from determining the best operative strategy, either an open approach, total endovascular repair, or a hybrid of the two. Hybrid aortic arch repair involves 2 steps—open aortic branch revascularization and endovascular aortic repair. 1 Gregory AJ Prusinkiewicz CA Herget E et al. Subclavian graft thrombosis as an alternative cause for delayed spinal cord ischemia following hybrid aortic arch repair. J Cardiothorac Vasc Anesth. 2014; 28: 718-722 Google Scholar Variations of these 2 steps may be used. Each involves its own set of risks.