A 50-year-old female patient, treated with stent graft for complicated TBAD 6 months ago, is brought to the emergency room for massive hemoptysis associated with hypovolemic shock. The computed tomography scan shows enlargement of the aorta's isthmus with endoleak type I, compression of the left main bronchus, and aortobronchial fistula ( Fig. 1 : Case 1). The ascending aorta appears normal. The patient is in circulatory shock prior to entering the operating room. 
 A selective intubation is performed. The intubation is carried out with sternolaparotomy (Mercedez Benz), cardiopulmonary bypass with double-arterial (right axillary/right femoral) cannulation (Cannula EOPA TM Arterial Cannulae, Medtronic, United States), and venous cannula (Edwards Lifesciences, Irvine, CA) in the right atrium. During deep hypothermia circulatory arrest (DHCA) the dissection is completed, the ascending aorta is clamped, and cardioplegia infused. Next, the supraceliac aorta is clamped, and femoral cannula performs the visceral protection. The distal end of the descending aorta is closed, and it is excluded from the circulation, and the ascending aorta-supraceliac aorta bypass is constructed (end-to-end) with a Dacron graft # 20 (Hemagard, Maquet, Germany) ( Fig. 2A ). 
 At 18 C the innominate artery is clamped, preserving axillary and visceral perfusion. The aortic arch is opened, and the stent graft is extracted ( Fig. 2B ). The distal arch is closed with a Dacron patch. The proximal anastomosis of the ascending aorta-abdominal aorta (end-to-side) is completed. Then, the airway is decompressed by removing clots from the descending aorta ( Fig. 2C ) confirmed by bronchoscopy. Several days after surgery, the patient evolves with sepsis, abscess of the residual aortic sac, which is communicated with the airway, requiring left pneumonectomy. The patient was discharged after 60 days of hospitalization. No neurological complication was observed.