Single-stage repair of extended thoracic aortic aneurysm.

We report the case of a 78-year-old man with an extended thoracic aortic aneurysm in whom replacement of the ascending aorta, aortic arch, and descending aorta were performed by single-stage repair. Single-stage repair surgical approach in this case was selected rather than two-stage repair because of the risk of rupture of the aneurysm in the period before the second surgery and the patient's somewhat unstable mental condition that could have reduced his motivation for a second surgery. At surgery, replacement of descending aorta was performed with thoracotomy in a right semisupine position, and replacement of ascending aorta and aortic arch was performed with a median sternotomy in the supine position by changing the position of the left forearm. The postoperative course was smooth without major complications. This case illustrates that the choice of surgical procedure should be made based on the shape of the aortic aneurysm and the mental and general conditions of the patient.