PMC6590405_01
Preoperative magnetic resonance image and enhanced computed tomography. A, Multiple fresh mycotic brain infarctions were detected. B, Severe stenosis of the right internal carotid artery was detected. C, Vegetation was detected in the brachiocephalic graft branch. D, Vegetation was detected in the left common carotid branch
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The patient gradually became drowsy, and brain magnetic resonance imaging revealed multiple fresh cerebral infarctions and severe right internal carotid artery stenosis (Figure 1A and B). Enhanced computed tomography showed vegetations inside the origin of the graft branch to the brachiocephalic artery and the left common carotid artery (Figure 1C and D).
Schema and steps in the surgical procedure. An infected graft was removed and in situ branched pericardial roll graft replacement was performed to create a neo-aorta. 1) Distal anastomosis. A branched xenopericardial sheet is formed into a cylinder to enable cross-clamping after step 4. 2) Anastomosis of the left common carotid artery. 3) Antegrade perfusion. 4) Anastomosis of the innominate artery. 5) Proximal anastomosis
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A sternocleidomastoid muscle pedicled flap was used to fill the subclavian cavity (Figure 2).
Postoperative 3-dimensional computed tomography image acquired 36 months postoperatively. There are no stenoses, no calcifications, no thrombus formation, and no pseudoaneurysms of the neo-aorta or its branches
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