A Case of Descending Graft Replacement of the Anastomotic Aneurysm Using Simple Hypothermic Retrograde Cerebral Circulation 9 Years after Surgery of the Distal Aortic Arch

Akihiko Sasaki Junichi Sakata Hiroki Satou
Teruhisa Kazui*

(Department of Cardiovascular Surgery, Sunagawa Medical Center, Sunagawa, Japan and Department of Surgery I, Hamamatsu Medical College*, Hamamatsu, Japan)

Anastomotic aneurysm was diagnosed in a 77-year-old man following graft replacement of the distal aortic arch aneurysm using the inclusion method in 1991. Enhanced CT demonstrated the aneurysm of the distal anastomotic site with a maximum diameter of 5cm between the graft and the aneurysmal wall. On left thoracotomy the aneurysm was found to severely adhere to the lung, so it was difficult to dissect its adhesion and clamp the proximal aorta. The rectal temperature was cooled to 18°C with the aid of femoro-femoral bypass. We anastomosed the previous graft-end to the new graft with one side branch during simple hypothermic retrograde cerebral circulation (RCC). RCC time was 16min and the distal end was anastomosed to the descending thoracic aorta. Though it took a long time to undertake systemic cooling and rewarming, intraoperative bleeding was small and the postoperative course was satisfactory without cerebral complication.
 Jpn. J. Cardiovasc. Surg.31:311-313 (2002)