Kyobu Geka. The Japanese Journal Of Thoracic Surgery[JOURNAL]
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200 papers
[Intraoperative Catheter Embolization for Pulmonary Artery Injury Caused by a Pulmonary Artery Catheter].
Terazono K, Nagasawa A, Ueda H … +4 more , Wada Y, Mihara H, Marui A, Ohno N
Kyobu Geka · 2025 Aug · PMID 40840876
We report two cases of intraoperative transcatheter embolization for pulmonary artery injury caused by a pulmonary artery catheter( PAC). The 1st case who had severe mitral regurgitation and tricuspid regurgitation with...
We report two cases of intraoperative transcatheter embolization for pulmonary artery injury caused by a pulmonary artery catheter( PAC). The 1st case who had severe mitral regurgitation and tricuspid regurgitation with giant left and right atrium underwent mitral and tricuspid annuloplasty. The 2nd case woman underwent aortic valve replacement and coronary artery bypass grafting. Sudden massive hemoptysis occurred during weaning from cardiopulmonary bypass in both cases, and pulmonary artery injury due to PAC was diagnosed. Both cases underwent pulmonary arteriography via the main pulmonary artery trunk and transcatheter embolization, and successful hemostasis was obtained. During intraoperative endovascular treatment, an approach via the main pulmonary artery trunk is very useful for diagnosis and treatment.
[Successful Identification of Thoracic Duct with Tumor-related Chylothorax by Fluorescence Imaging with Indocyanine Green via Inguinal Lymph Node].
Matsuoka H, Yamada R, Takehara E … +3 more , Hokimoto N, Yoshida M, Tanida N
Kyobu Geka · 2025 Aug · PMID 40840875
A 60-year-old woman underwent treatment for breast cancer. She underwent thoracic drainage and was treated with dietary restriction for tumor-related chylothorax. However, after a lack of improvement, she underwent surgi...
A 60-year-old woman underwent treatment for breast cancer. She underwent thoracic drainage and was treated with dietary restriction for tumor-related chylothorax. However, after a lack of improvement, she underwent surgical ligation of the thoracic duct. Indocyanine green (ICG) fluorescence with inguinal lymph node puncture was used to identify the thoracic duct. This technique was effective in intraoperatively identifying the main and collateral branches of the thoracic duct. Inguinal lymph node puncture is a simple procedure. Because the presence of collateral branches is a factor in the failure of thoracic duct ligation, this method, which can also identify the collateral branches of the thoracic duct during surgery, may increase the success rate of thoracic duct ligation.
[Distal Stent Graft-induced New Entry on the Lesser Curvature of Distal Aortic Arch:Report of a Case].
Saga T, Koga M, Izuka S … +1 more , Miyagawa H
Kyobu Geka · 2025 Jul · PMID 40676745
A 62-year-old male was admitted for cerebral hemorrhage, enhanced computed tomography (CT) revealed a dissecting thoracic aortic aneurysm in the distal arch. Following cerebral hemorrhage treatment, the patient was refer...
A 62-year-old male was admitted for cerebral hemorrhage, enhanced computed tomography (CT) revealed a dissecting thoracic aortic aneurysm in the distal arch. Following cerebral hemorrhage treatment, the patient was referred to our department and underwent a total arch replacement using the frozen elephant trunk (FET) technique. The patient was followed up regularly post operatively at our hospital. Enhanced CT at 31 months post surgery revealed a distal stent graft-induced new entry (dSINE) on the lesser curvature of the distal arch. Additional thoracic endovascular aortic repair (TEVAR) was performed. Although dSINE can be caused by various factors, it is usually seen on the greater curvature of the aorta and is relatively rare on the lesser curvature, as in this case in Japan. We will discuss the mechanisms underlying the development of dSINE on the lesser curvature with reference to the literature.
[Surgery for Cardiac Rhabdomyosarcoma in Jehovah's Witnesses:Report of a Case].
Tsunemoto H, Otsu Y, Senda K
Kyobu Geka · 2025 Jul · PMID 40676744
Primary cardiac malignant neoplasms are rare, and rhabdomyosarcoma is the second most common cardiac sarcoma. We herein report a rare case of 70-year-old female with a cardiac rhabdomyosarcoma in the posterior wall of th...
Primary cardiac malignant neoplasms are rare, and rhabdomyosarcoma is the second most common cardiac sarcoma. We herein report a rare case of 70-year-old female with a cardiac rhabdomyosarcoma in the posterior wall of the left atrium. She was a member of Jehovah's Witnesses. We performed surgical tumor resection and mitral valve replacement because of apparent tumor invasion to the posterior leaflet of the mitral valve without blood transfusion. Postoperative course was uneventful and she was scheduled to undergo proton beam therapy. This is the first case report of surgically treated cardiac rhabdomyosarcoma in a Jehovah's Witness.
[Anterolateral Partial Sternotomy as an Effective Approach for Open Repair After Debranching Thoracic Endovascular Aortic Repair in Aortic Arch Aneurysm].
Sato M, Hayashi T, Taniguchi S … +1 more , Goto T
Kyobu Geka · 2025 Jul · PMID 40676743
Thoracic endovascular aortic repair (TEVAR) has become a common minimally invasive option for aortic surgery, often accompanied by debranching of the aortic arch branches. However, TEVAR-specific complications occasional...
Thoracic endovascular aortic repair (TEVAR) has become a common minimally invasive option for aortic surgery, often accompanied by debranching of the aortic arch branches. However, TEVAR-specific complications occasionally necessitate open repair. In such cases, especially in patients with complex aortic arch pathology, the choice of surgical approach is critical. In this case, considering the unique background of cold agglutinin disease, we opted for an anterolateral partial sternotomy approach. This approach provided excellent exposure for aortic manipulation and allowed preservation of the existing bypass grafts, contributing to a successful outcome. We believe that this technique can be effectively applied in similar complex cases requiring open repair after debranching TEVAR.
[Therapeutic Experience with Three-port Thoracoscopic Lung Volume Reduction Surgery for Emphysema].
Suzuki S, Fujimori S, Karasaki T … +3 more , Kikunaga S, Hamada Y, Mihara S
Kyobu Geka · 2025 Jul · PMID 40676742
Lung volume reduction surgery( LVRS) and lung transplantation have proven to be effective surgical treatments for emphysema. However, since the results of the National Emphysema Treatment Trial (NETT) study, there has be...
Lung volume reduction surgery( LVRS) and lung transplantation have proven to be effective surgical treatments for emphysema. However, since the results of the National Emphysema Treatment Trial (NETT) study, there has been a sharp decline in the number of LVRS cases in Japan, and few patients are eligible for lung transplantation due to donor problems, so bronchoscopic lung volume reduction (BLVR) is expected to be an effective treatment in the future. In our department, LVRS was performed in 22 cases out of approximately 10,000 thoracoscopic procedures from 1999 to 2024. The overall postoperative forced expiratory volume in on second (FEV1.0) improvement rate was 45%, especially 61% for bilateral surgery. If postoperative complications can be safely controlled, LVRS can be expected to have better outcomes than BLVR for bilateral upper lobe dominant forms of emphysema.
[Lung Volume Reduction Surgery for Severe Emphysema].
Yoshimatsu K, Takenaka M, Fujita Y … +5 more , Hashimoto T, Tanaka K, Nemoto Y, Matsumiya H, Tanaka F
Kyobu Geka · 2025 Jul · PMID 40676741
Lung volume reduction surgery( LVRS) is performed in patients with severe emphysema who do not respond to medical therapy. We report two cases of LVRS that resulted in favorable outcomes. We used a method in which the cy...
Lung volume reduction surgery( LVRS) is performed in patients with severe emphysema who do not respond to medical therapy. We report two cases of LVRS that resulted in favorable outcomes. We used a method in which the cyst wall is incised, the cyst base is covered with fibrin glue and polyglycolic acid (PGA) sheets, and the cyst wall is resected using an automatic suturing device. In the first case, respiratory failure was observed preoperatively, and home oxygen therapy was introduced. However, minimally invasive LVRS was performed using a thoracoscopic approach, resulting in a good outcome for the patient. In the second case, a giant cyst and pneumothorax coexisted, suggesting the difficulty of preoperative differentiation.
[Surgical Treatment of Emphysema].
Konoeda C
Kyobu Geka · 2025 Jul · PMID 40676740
Lung volume reduction surgery (LVRS) and lung transplantation are surgical treatment options for emphysema. While lung transplantation is generally considered to be the final treatment option because of its high risk, it...
Lung volume reduction surgery (LVRS) and lung transplantation are surgical treatment options for emphysema. While lung transplantation is generally considered to be the final treatment option because of its high risk, it can be considered as the first option in patients aged <60 years with severe respiratory failure and %FEV1.0 <20%. Patients with %FEV1.0 20-45% and computed tomography (CT) findings of heterogeneously distributed emphysema, with better preserved lung tissue in some areas compared with other areas, may be suitable candidates for LVRS. In particular, patients with predominantly upper lung zone emphysema are more likely to benefit from LVRS than other patients. In this report, we describe three emphysema patients who underwent LVRS, and then discuss the essential factors that should be taken into consideration during candidate selection for LVRS or lung transplantation.
[Early and Long-term Results of Lung Volume Reduction Surgery for Severe Chronic Obstructive Pulmonary Disease Patient with Target Area Not Restricted in Upper Lobe].
Chihara K, Nakai M, Sahara H … +1 more , Tamari S
Kyobu Geka · 2025 Jul · PMID 40676739
The basic patient selection criteria in lung volume reduction surgery (LVRS) is that the target area (TA) is located in the upper lobe since National Emphysema Treatment Trial (NETT). TA could be described as "airoma" (A...
The basic patient selection criteria in lung volume reduction surgery (LVRS) is that the target area (TA) is located in the upper lobe since National Emphysema Treatment Trial (NETT). TA could be described as "airoma" (AO) with excess residual volume and poor perfusion, which compresses the adjacent lung and heart during expiration and causes dyspnea during walking. After Cooper's landmark report, we defined AO not only by functional static images such as high resolution computed tomography(HRCT) and perfusion scintigrams but also dynamic image of magnetic resonance imaging( MRI)during ventilation, and selected 36 patients with a mean age of 69 years, body mass index (BMI) of 18 kg/m2, modified Medical Research Council( mMRC) of 2.7, PaO2 of 68 mmHg, PaCO2 of 44 mmHg, forced expiratory volume in on second( FEV1)% of 29, % residual volume( RV) of 255, 6-min walk of 285 m, and VO2 max of 12.5 ml/kg/min from October 1995 to October 2015. AO was located in the upper lobe in 19 patients, in the lower lobe in 13 patients, and in the middle lobe or bi-lobes in 4 patients. Reduction of AO was performed by median sternotomy or video-assisted thoracic surgery (VATS). There was zero 90-day operative mortality and zero in-hospital mortality. Thirty-three of 36 patients were satisfied with decrease in dyspnea during walking, and three disappointed. The median follow-up for all patients was 4.5 years. The 1, 3, and 5-year survival rates in the upper lobe group were 100%, 94%, and 49%, respectively, compared with 92%, 77%, and 54%, respectively, in the lower lobe group. There was no difference in survival between the two groups. We believe that selected patients with lower lobe AO are candidates for LVRS, as well as upper lobe AO.
[Lung Volume Reduction for Chronic Obstructive Pulmonary Disease].
Terada Y, Yuki H, Nishikawa S … +4 more , Wada T, Saito D, Kakegawa S, Matsumoto I
Kyobu Geka · 2025 Jul · PMID 40676738
Chronic obstructive pulmonary disease (COPD) is increasing with population aging and currently ranks as the third leading cause of death worldwide, accounting for approximately three million deaths annually. COPD is char...
Chronic obstructive pulmonary disease (COPD) is increasing with population aging and currently ranks as the third leading cause of death worldwide, accounting for approximately three million deaths annually. COPD is characterized by irreversible airflow obstruction, mainly caused by reduced lung elastic recoil due to peripheral airway lesions and emphysema. This condition results in lung hyperinflation, causing dyspnea, reduced exercise capacity, decreased physical activity, and an increased risk of heart failure. For patients with severe COPD unresponsive to medical therapies, surgical interventions, such as lung volume reduction surgery (LVRS), bronchoscopic lung volume reduction (BLVR), or lung transplantation, are considered. LVRS improves respiratory function by surgically removing hyperinflated lung tissue;however, due to its invasiveness and complication risks, fewer than 20 cases are performed annually in Japan. In contrast, BLVR, particularly bronchoscopic valve placement, is less invasive and has demonstrated effectiveness, especially in patients without collateral ventilation, and was approved for insurance coverage in Japan in 2023. Recent trials indicate BLVR significantly improves respiratory function and quality of life, though pneumothorax remains a notable complication. Appropriate patient selection based on clinical features, imaging findings, and pulmonary function evaluation is crucial, emphasizing individualized therapeutic strategies for COPD management.
[Volume Reduction Surgery for Advanced Emphysema is Still Worthwhile to Be Considered].
Kohno T
Kyobu Geka · 2025 Jul · PMID 40676737
Lung volume reduction surgery for emphysema became popular in 1990's and became less common afterward. In emphysema patients, pleural pressure becomes positive and it restricts the diaphragm movement and the patency of b...
Lung volume reduction surgery for emphysema became popular in 1990's and became less common afterward. In emphysema patients, pleural pressure becomes positive and it restricts the diaphragm movement and the patency of bronchioles. The pleural pressure becomes negative after reducing the lung volume and make the diaphragm motion better and keep the bronchioles open. In order not to compromise the respiratory muscle, this operation is usually performed through median sternotomy or thoracoscopic approach. These days, the buttress materials were improved and there are still report for good results of this procedure, I believe this procedure should be one of the option for emphysema patients.
[Bronchoscopic Lung Volume Reduction for Severe Emphysema].
Nakano T, Notsuda H, Onodera K … +3 more , Watanabe T, Hirama T, Okada Y
Kyobu Geka · 2025 Jul · PMID 40676736
Bronchoscopic lung volume reduction (BLVR) using endobronchial valves is a minimally invasive treatment for severe emphysema. Although lung volume reduction surgery( LVRS) has been employed in selected patients, its high...
Bronchoscopic lung volume reduction (BLVR) using endobronchial valves is a minimally invasive treatment for severe emphysema. Although lung volume reduction surgery( LVRS) has been employed in selected patients, its high complication rate and limited functional improvement have led to a shift toward non-surgical options. In September 2024, we performed our first BLVR procedure in a transplant candidate who met all eligibility criteria. The patient showed improvement in symptoms and pulmonary function. However, case recruitment remains challenging due to the strict inclusion criteria and limited awareness of BLVR. We report our initial clinical experience, highlight issues in patient selection and recruitment, and discuss the potential of BLVR as a bridging therapy for lung transplantation. In addition, we emphasize its possible utility in elderly or inoperable patients with advanced chronic obstructive pulmonary disease (COPD). Broader dissemination and revision of current eligibility criteria may facilitate wider adoption of this promising therapy.
[Bronchoscopic Lung Volume Reduction for Severe Chronic Obstructive Lung Disease].
Nakajima T, Inoue T, Okutomi H … +5 more , Takemasa A, Shimizu Y, Maeda S, Niho S, Chida M
Kyobu Geka · 2025 Jul · PMID 40676735
Bronchoscopic lung volume reduction( BLVR) has a history of over 10 years and has been performed in more than 25,000 cases worldwide. It is recommended with an evidence A rating in the Global Initiative for Chronic Obstr...
Bronchoscopic lung volume reduction( BLVR) has a history of over 10 years and has been performed in more than 25,000 cases worldwide. It is recommended with an evidence A rating in the Global Initiative for Chronic Obstructive Lung Disease( GOLD) guidelines. However, in Japan, it was only approved for insurance coverage in December 2023, and treatment has just begun at designated facilities. BLVR serves as a treatment option that bridges the gap between medical and surgical treatments for severe chronic obstructive pulmonary disease (COPD) cases. In Japan, where homogeneous emphysema is more prevalent, BLVR offers a promising new treatment option for severe COPD patients who continue to experience dyspnea despite receiving maximal medical therapy. The success of BLVR depends on proper patient selection based on appropriate evaluation, including the assessment of collateral ventilation using the Chartis system. Patients undergoing BLVR can expect improvements in FEV1.0 and the six-minute walk distance, ultimately leading to better survival rates. It is hoped that BLVR will help severe COPD patients break free from the negative spiral of COPD, maintain their quality of life, and ultimately contribute to reducing COPD-related mortality.
[Lung Volume Reduction Surgery in the Bronchoscopic Lung Volume Reduction Era:Reassessment of Indications and Strategies].
Tanaka S, Tomioka Y, Yamamoto H … +7 more , Torigoe H, Shien K, Suzawa K, Miyoshi K, Okazaki M, Sugimoto S, Toyooka S
Kyobu Geka · 2025 Jul · PMID 40676734
Bronchoscopic lung volume reduction( BLVR) and lung volume reduction surgery( LVRS) represent two complementary strategies in the management of advanced emphysema. BLVR has emerged as a minimally invasive and reversible...
Bronchoscopic lung volume reduction( BLVR) and lung volume reduction surgery( LVRS) represent two complementary strategies in the management of advanced emphysema. BLVR has emerged as a minimally invasive and reversible approach, demonstrating significant clinical benefit in carefully selected patients without collateral ventilation, supported by advances in physiological assessment and imaging technologies. LVRS, by contrast, remains a well-validated surgical option offering sustained improvements in pulmonary mechanics, exercise tolerance, and quality of life, particularly in patients with heterogeneous upper-lobe predominant disease. Recent randomized trials have underscored the comparable efficacy of both modalities, highlighting the need for individualized, phenotype-driven treatment planning. A multidisciplinary, individualized approach is essential to optimize treatment selection.
[Mediastinal Cavernous Hemangioma with Concurrent Primary Lung Cancer Resected by Thoraco scopic Surgery:Report of a Case].
Suzuki H, Shinoda M, Ito D … +5 more , Shoumura S, Tanabe M, Sawada Y, Inoue K, Shimamoto A
Kyobu Geka · 2025 May · PMID 40589049
Cavernous hemangiomas of the mediastinum (CHM) are relatively rare, accounting for 0.5% of all mediastinal neoplasms, and they are difficult to diagnose preoperatively. Here, we reported a CHM with a primary lung carcino...
Cavernous hemangiomas of the mediastinum (CHM) are relatively rare, accounting for 0.5% of all mediastinal neoplasms, and they are difficult to diagnose preoperatively. Here, we reported a CHM with a primary lung carcinoma. A 69-year-old female was referred to our hospital. The chest computed tomography( CT) revealed multiple ground glass nodules in the upper and lower lobes of the right lung and an anterior mediastinal mass enhanced heterogeneously. The patient underwent video-assisted thoracoscopic surgery for the right S6 and the mediastinal tumor. A final diagnosis of CHM with concurrent lung adenocarcinoma was made. Cavernous hemangioma should be considered to be concomitant with lung cancer although it is rare.
[Angiolipoma Arising in the Posterior Mediastinum:Report of a Case].
Onda T, Kita H, Yoshida T … +1 more , Hayashi T
Kyobu Geka · 2025 May · PMID 40589048
The patient was an 82-year-old man. A posterior mediastinal tumor was noted on chest computed tomography (CT). Magnetic resonance imaging (MRI) scan showed a high signal on both T1- and T2-weighted imaging. Lipoma was su...
The patient was an 82-year-old man. A posterior mediastinal tumor was noted on chest computed tomography (CT). Magnetic resonance imaging (MRI) scan showed a high signal on both T1- and T2-weighted imaging. Lipoma was suspected, but since the border with the vertebral body was partially unclear, video-assisted tumor resection was performed for diagnosis and treatment purposes. Finally, we diagnosed it as non-infiltrating angiolipoma. Angiolipoma is a benign tumor that accounts for 5-17% of all lipomas. Pathologically, they can be divided into two types:infiltrating and non-infiltrating. Most are non-infiltrating, but recurrent cases of the infiltrating type have been reported. Angiolipoma commonly occurs in subcutaneous tissues of the upper extremity and trunk, but we report a rare case that occurred in the posterior mediastinum.
[Effectiveness of Decompressive Craniectomy for Severe Cerebral Infarction Caused by Stanford Type A Acute Aortic Dissection:Report of a Case].
Shimada M, Yasutsune T, Umesue M
Kyobu Geka · 2025 May · PMID 40589047
The optimal surgical management of Stanford type A acute aortic dissection complicated by severe cerebral infarction remains controversial. We present a case of a 48-year-old man with Stanford type A acute aortic dissect...
The optimal surgical management of Stanford type A acute aortic dissection complicated by severe cerebral infarction remains controversial. We present a case of a 48-year-old man with Stanford type A acute aortic dissection complicated by malperfusion of the right common carotid artery. His consciousness was deteriorating preoperatively, and we performed an emergent aortic root replacement and partial aortic arch replacement. He suffered a severe cerebral edema with a brain herniation caused by cerebral infarction after the surgery. Decompressive craniectomy saved his life and improved his neurologic functions, and he has become able to communicate well. It is suggested that the decompressive craniectomy for the severe cerebral infarction after a surgery for type A acute aortic dissection with cerebral malperfusion is a good option for better neurologic outcomes.
[Retrograde Stanford Type A Aortic Dissection Following Thoracic Endovascular Aortic Repair for Stanford Type B Aortic Dissection:Report of a Case].
Kinoshita H, Hiroshima Y, Fujimoto E … +2 more , Kano M, Chikugo F
Kyobu Geka · 2025 May · PMID 40589046
A male patient in his 60s developed acute Stanford type B aortic dissection with malperfusion of the lower limbs in early June. Emergency surgery was performed. The surgery aimed to close the entry in the distal arch and...
A male patient in his 60s developed acute Stanford type B aortic dissection with malperfusion of the lower limbs in early June. Emergency surgery was performed. The surgery aimed to close the entry in the distal arch and involved a debranched thoracic endovascular aortic repair (TEVAR). Postoperatively, malperfusion improved, but a type 1a endoleak persisted, and the distal arch aneurysm enlarged. Therefore, an additional TEVAR was performed in early October. Compared to the previous procedure, this TEVAR was placed just after the brachiocephalic artery in the central side. One week after surgery, the patient experienced severe chest pain in the early morning, prompting an emergency computed tomography (CT) scan. The diagnosis was retrograde type A aortic dissection (RTAD), and urgent surgery was planned. While considering blood supply options, the possibility of using blood from the previously debranched artificial vessel was evaluated. However, due to concerns about the narrow diameter of the artificial vessel and ensuring sufficient full flow, blood supply was performed from the cardiac apex. The entry of the dissection was located at the level of the brachiocephalic artery on the lesser curvature side, and an ascending arch aortic replacement was performed. The patient was extubated the day after surgery, and the postoperative course was favorable. The choice of blood supply for RTAD remained a challenge. Despite the risk of malperfusion with retrograde femoral artery blood supply, the surgeon chose the familiar cardiac apex approach, ultimately saving the patient's life.
[Hybrid Aortic Arch Debranching for Challenging Access Following Abdominal Aorta Resection:Report of a Case].
Yusa H, Tanabe T, Hanzawa Y … +1 more , Tei I
Kyobu Geka · 2025 May · PMID 40589045
Eight years previously, a 76-year-old man underwent an open surgical repair of an infectious abdominal aortic aneurysm through a median laparotomy. The abdominal aorta was resected, and blood flow to the lower extremitie...
Eight years previously, a 76-year-old man underwent an open surgical repair of an infectious abdominal aortic aneurysm through a median laparotomy. The abdominal aorta was resected, and blood flow to the lower extremities was reconstructed using an extra-anatomical bypass from the right axillary artery to the bilateral femoral arteries. A computed tomography (CT) scan revealed a distal aortic arch aneurysm just below the left subclavian artery, with a maximum diameter of 58 mm. Given the high-risk nature of an open surgery, we opted for an endovascular intervention. However, accessing the aneurysm from the iliac and femoral arteries was challenging. Therefore, we accessed the ascending aorta after total debranching. A median sternotomy was performed under general anesthesia. Total debranching of the supra-aortic vessels was accomplished without cardiopulmonary bypass by using a side clamp on the ascending aorta. After total debranching, Gore TAG grafts were positioned from zone 0 to Th10. The postoperative course was uneventful, without any complications, and the postoperative enhanced CT revealed no endoleaks.
[Staged Hybrid Repair with Branched Collared Graft for Extensive Thoracic Aortic Aneurysm and Shaggy Aorta:Report of a Case].
Ito F, Kataoka G, Watanabe M
Kyobu Geka · 2025 May · PMID 40589044
The patient, a 64-year-old woman, presented with chest and back pain. A computed tomography( CT) scan revealed extensive dilatation of the entire thoracic aorta, along with a shaggy lesion and significant mural thrombus....
The patient, a 64-year-old woman, presented with chest and back pain. A computed tomography( CT) scan revealed extensive dilatation of the entire thoracic aorta, along with a shaggy lesion and significant mural thrombus. A two-stage hybrid surgical approach was undertaken. In the first stage, ascending and total arch aortic replacement was performed using a four-branched collared graft (Gelweave ET), along with the placement of a conventional elephant trunk( CET). The second stage, thoracic endovascular aortic repair( TEVAR), was successfully performed on postoperative day eight. No major postoperative complications were observed. This staged approach, combining total arch replacement with CET placement via median sternotomy followed by TEVAR, provided a less invasive and safer alternative, particularly in minimizing the risk of cerebral infarction.
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