A case report of surgical repair for distal aortic arch aneurysm with abdominal aortic aneurysm

A 77-year-old female was referred to our hospital with hoarseness and an abnormal shadow on her chest X ray film. Computed tomography and aortography revealed aneurysms of the distal aortic arch and the infrarenal abdominal aorta. Total aortic arch replacement was performed successfully on the patient, utilizing hypothermic selective cerebral perfusion. The operation employed three technical characteristics for avoidance of cerebral complication. Those were as follows: First, total aortic arch replacement was performed instead of distal aortic arch replacement because of severe sclerosis of the proximal aortic arch. Secondly, to prevent cerebral embolism due to the thrombi on the wall of the abdominal aortic aneurysm, an arterial cannula for cardiopulmonary bypass was inserted in the ascending aorta initially and after completion of the distal anastomosis, it was placed on the graft. Thirdly, the so called "non clamping technique" operation was employed because clamping onto the sclerotic arteries might have caused cerebral embolism. There was no cerebral complication and the postoperative course was satisfactory.