Development of Mega-Aorta Following Incompletely Treated Giant Cell Arteritis.

An 82-year-old male presented with a 9.3 cm ascending aorta and arch aneurysm with additional aneurysms of the innominate, right subclavian, and left common carotid arteries. The patient had a history of temporal arteritis that was only briefly treated in 1989 and a 6 cm ascending aortic aneurysm that was repaired in 1993. Our operative strategy was to construct a temporary parallel cerebrovascular circuit for cerebral protection during the redo-sternotomy and aortic arch reconstruction, with the added benefit of permanently excluding the branch arch vessel aneurysms. Pathological analysis of the aortic specimen at the first operation may have identified giant cell arteritis, prompting medical therapy against further disease progression.