Fig. 3 A) Anteroposterior and B) lateral view 3-dimensional computed tomographic angiographic reconstructions of the aorta after “hybrid” repair in a patient with Loeys-Dietz syndrome (LDS). Six years after aortic root replacement for repair of an acute type A dissection at age 45, the patient underwent Crawford extent III replacement of a thoracoabdominal aortic aneurysm (TAAA) that enlarged secondary to chronic dissection. A year later, repeat sternotomy for total aortic arch replacement via the elephant-trunk technique was performed for an enlarging transverse arch/proximal descending aneurysm; to complete treatment of the LDS aortic disease, staged endovascular exclusion of the remainder of the chronically dissected aorta was performed during the same hospitalization. Long-segment landing zones for the endografts lay proximally within the Dacron elephant-trunk graft and distally within the Dacron TAAA graft above the takeoff of the side branch to the celiac axis. A hybrid technique was chosen because of the patient's severe scoliosis in union with an extremely tortuous descending aorta that crossed over into the right side of the chest during part of its course.