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  • Title: Modified perfusion strategy and aortic arch debranching in complicated acute aortic dissection type A: a bridge to definitive endovascular therapy.
    Author: Rylski B, Siepe M, Blanke P, Kari FA, Schoellhorn J, Beyersdorf F.
    Journal: Ann Thorac Cardiovasc Surg; 2014; 20(6):1038-41. PubMed ID: 23445803.
    Abstract:
    INTRODUCTION: Patients with acute aortic dissection type A (AADA) with aortic arch and supra-aortic vessel involvement have a higher postoperative stroke prevalence and risk of later aortic arch aneurysm development. CASE REPORT: We report a case of AADA with involvement of supraaortic arteries, complicated by cerebral malperfusion. The ascending aorta was replaced using bilateral antegrade cerebral perfusion through side-grafts attached to both carotid arteries, which were subsequently used as aorto-bi-carotid bypass. One year later, the diameter of aortic arch increased to 5 cm. The endovascular treatment of aortic arch was easily performed since debranching was already almost complete. CONCLUSIONS: Immediate bilateral carotid artery inflow and subsequent aorto-bi-carotid bypass is a safe way to prevent cerebral malperfusion in the setting of complicated AADA.A potential benefit of this technique is almost complete debranching that facilitates an endovascular arch replacement.
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