The anatomical situation of posterior aortic arch aneurysms is a surgical challenge. The surgical approach should not only guarantee a safe dissection of the supra-aortic trunks and the descending aorta but also allow the cannulation for extracorporeal circulation. Indeed, protecting the cerebral flow is essential. Another challenge is to preserve both the phrenic and recurrent nerves while sparing chest wall muscles. A hemiclamshell approach for posterior aortic arch aneurysm seems to be a good compromise regarding these requirements.
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