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Background  We describe a modified access technique for the proximal (open) part of single stage hybrid exclusion of aneurysm of the aortic arch.    Case presentation  3 patients had a bifurcated Dacron graft for the innominate and left subclavian arteries and an additional end-to-side anastomosis of the left common carotid artery on the limb to the left subclavian artery. With our modification, access to the left subclavian artery is by left subclavicular incision and creation of an anterior tunnel via the left thoracic outlet from the origin of the left subclavian artery along its anatomical course to the subclavicular plane.    Discussion  Advantages and disadvantages of this technique in relation to anatomy and pathology.

Combined sterno-clavicular approach as an alternative technique in hybrid exclusion of aortic arch aneurysm