PMC10025532_01
Preoperative CT scan showing (A) an acute type A dissection compromising the aortic arch and origin of supra-artic vessels. (B) A complete occlusion of the brachiocephalic trunk, with reperfusion of the right subclavian artery; a complete occlusion of the left common carotid artery; a dissected left subclavian artery. (C) A coronal reconstruction showing complete occlusion of both common carotid arteries since origin at the aortic arch (arrows). (D) A coronal reconstruction showing reperfusion at the level of the left carotid bifurcation (arrow).
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F1
The left common carotid artery was also occluded and thrombosed, showing recovered flow just before the bifurcation (Figure 1).
Intraoperative images showing (A) perfusion setup with direct ascending aorta (AA) cannulation in the uncompromised segment (*), pediatric cannulas to the right subclavian (RSA) and left internal carotid arteries, and Dacron graft to the left subclavian artery (arrows). The white lines depict the cross-clamp site to allow for cardiac perfusion through the aortic cannula. The innominate artery (IA), left carotid artery (LCA) and left subclavian artery (LSA) are also appreciated. (B) The final result with the Thoraflex deployed, and its branches anastomosed to the right subclavian artery, left carotid bifurcation, and left subclavian artery (arrows).
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F2
For the subclavian branches, we obtained flow from the systemic cannula (Figure 2). The left carotid anastomosis was performed at the level of the carotid bifurcation (Figure 2).