Anatomical limitations have been identified as barriers to the more widespread application of thoracic endovascular aortic repair. Here, we report a case in which a novel technique was used as a solution for an extremely dilated aortic landing zone. An elderly gentleman in profound shock was diagnosed with a ruptured distal aortic arch aneurysm. Open repair was considered, but owing to the presence of multiple comorbidities and an extremely dilated aorta in the landing zone (45 mm) which made thoracic endovascular aortic repair infeasible, it appeared to entail a high risk for perioperative morbidity and mortality. Therefore, to save the patient's life, we designed a novel double-barreled cannon thoracic endovascular aortic repair method, and further developed a formula for choosing appropriate stent graft sizes. The patient gradually recovered to baseline physical status after the operation.
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