2 ; however, the addition of balloon occlusion of the outflow graft allowed controlled exchange of the device without the need to surgically control and clamp the graft, 3 reducing surgical dissection and potential morbidity. Placement of a Foley catheter into the outflow graft 4 offers another option of controlling back bleeding from the aorta; however, connecting the outflow graft to the new device can be made difficult by uncontrolled bleeding because the Foley catheter must be removed. Furthermore, deairing of the outflow graft is more difficult with this approach, whereas endovascular control facilitates this process. We advocate a combined hybrid approach to device exchange in patients for whom minimal surgical trauma is paramount. FIGURE 3. Surgical incisions after skin approximation (A) and 6 months after surgery (B).
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