Open descending aortic replacement after Thoraflex hybrid graft implantation.

The Thoraflex hybrid graft has been widely used around the world to allow a single-stage treatment for multi-segment aortic pathologies. The distal stent graft component of the Thoraflex has made it exceptionally easy for endovascular second-stage procedures when compared with the floating elephant trunk. However, published reports on operative techniques for open second-stage procedures after Thoraflex are limited. In this video tutorial we describe our open second-stage after Thoraflex with special focus on the ideal anastomosis technique to achieve good hemostasis and an optimal surgical outcome.