144 Proximal fixation was enhanced in our patient by deploying a graft with an extended bare proximal portion. This approach could ensure adequate anchorage without aortic arch branch occlusion, even in patients with short landing zones. Further- more, by transposing the LSCA onto the LCCA through the small supraclavicular incision, a full sternotomy could be avo- ided while preserving blood flow to the LSCA. Occlusion of the LSCA during unprotected stent insertion is frequently regarded as inconsequential. In summary, this report presents our first experience with hybrid TAR, combining supra-aortic branch transposition with endovascular stent-grafting. Currently available tech- niques for stent-grafting of the descending aorta, combined with minimally invasive debranching procedures, may lead to the further development of safe and effective strategies that will avoid the high risks associated with conventional open surgery. REFERENCES 1. Rousseau H, Dambrin C, Marcheix B, Richeux L, Mazerolles M, Cron C, Watkinson A, Mugniot A, Soula P, Chabbert V, Canevet G, Roux D, Massabuau P, Meites G, Tran Van T, Otal P. Acute traumat- ic aortic rupture: a comparison of surgical and stent graft repair. J Thorac Cardiovasc Surg 2005; 129: 1050-5. Y.G. Ryu, S.J. Choo, J.Y. Lim, et al. 2. Kuhne CA, Ruchholtz S, Voggenreiter G, Eggebrecht H, Paffrath T, Waydhas C, Nast-Kolb D, AG Polytrauma DGU. Traumatic aortic injuries in severely injured patients. Unfallchirurg 2005; 108: 279-87. 3. Jahromi AS, Kazemi K, Safar HA, Doobay B, Cina CS. Traumatic aortic rupture of the thoracic aorta: cohort study and systematic review. J Vasc Surg 2001; 34: 1029-34. 4. von Oppell UO, Dunne TT, De Groot MK, Zilla P. Traumatic aor- tic rupture: twenty-year metaanalysis of mortality and risk of para- plegia. Ann Thorac Surg 1994; 58: 585-93. 5. Morgan R, Loosemore T, Belli AM. Endovascular repair of con- tained rupture of the thoracic aorta. Cardiovasc Intervent Radiol 2002; 25: 291-4. 6. Wellons ED, Milner R, Solis M, Levitt A, Rosenthal D. Stent-graft repair of traumatic aortic disruptions. J Vasc Surg 2004; 40: 1095- 100. 7. Buz S, Zipfel B, Mulahasanovic S, Pasic M, Weng Y, Hetzer R. Con- ventional surgical repair and endovascular treatment of acute trau- matic aortic rupture. Eur J Cardiothorac Surg 2008; 33: 143-9. 8. Doss M, Wood JP, Balzer J, Martens S, Deschka H, Moritz A. Emer- gency endovascular interventions for acute thoracic aortic rupture: four-year follow-up. J Thorac Cardiovasc Surg 2005; 129: 645-51. 9. Buth J, Harris PL, Hobo R, van Eps R, Cuypers P, Duijm L, Tielbeek X. Neurologic complications associated with endovascular repair of thoracic aortic pathology: Incidence and risk factors. A study from the European Collaborators on Stent/Graft Techniques for Aortic Ane- urysm Repai (EUROSTAR) registry. J Vasc Surg 2007; 46: 1103-10.