Novel approach to treating a coronavirus disease 2019–positive patient with a complex arch and descending aneurysm and dissection for whom open surgery was prohibitive

Ascending aortic and arch aneurysms are a challenging group of pathologies for surgeons. These typically require a complex open repair, including hypothermic circulatory arrest, and carry a high perioperative risk. The outcomes have been best when performed in centers with significant experience and expertise. Many patients, because of comorbidities, will have a prohibitive risk for these open surgeries. Thoracic endovascular aortic repair has become the preferred treatment of most acute descending thoracic aortic pathologies. However, these require strict anatomic criteria to be successful and will usually be confined to the distal arch and descending thoracic aorta. No commercial endovascular devices are available in the United States to treat this patient population with ascending or proximal arch aneurysms or dissections, especially in an urgent or emergent setting, whose anatomy does not meet the criteria for standard thoracic endovascular aortic repair. In the present report, we have described a novel endovascular approach, including a cerebral protection strategy, to treat a complex arch aneurysm and dissection in a patient who was not a candidate for an open repair.