An improved isolation technique for shaggy brachiocephalic artery and aortic arch replacement.

A mobile plaque in the ascending and transverse aorta increases the risk of cerebral infarction during treatment of an arch aneurysm. A previous report described an isolation technique for replacing the ascending and transverse aorta with a mobile atheroma by selective hypothermic antegrade cerebral perfusion (Shiiya et al., Ann Thorac Surg 72:1401-1402, 2001). Here, we present an improved isolation technique for more severe conditions, such as shaggy aorta and shaggy brachiocephalic artery, in two patients. First, we anastomosed both axillae arteries with grafts and placed drainage cannulae in the superior and inferior venae cavae prior to filling the cardio-pulmonary bypass system with blood. Next, we cannulated the right common carotid artery and selective cerebral perfusion was started prior to cannulation and perfusion of the left common carotid artery. Systemic perfusion was then initiated through the axillae grafts. Both patients who underwent this procedure recovered without neurologic complications.