Simplified technique for hemi-arch replacement during open distal anastomosis: the "calla" method.

During open distal anastomosis for type A dissecting aneurysm, the beveled end of the graft was rolled back like a bract of the Calla flower and inserted into the aortic lumen. The inverted graft was anastomosed using forehand continuous sutures. After completion of the distal anastomosis, the inverted graft was pulled out and then the proximal anastomosis was completed. This "Calla flower" deformation facilitates the hemostatic distal anastomosis in hemi-arch replacement during open distal anastomosis.