Aortic Surgery by Mike Poullis

Case 52

Frequent TIAs

A 55 year old gentleman presented to his local hospital with a series of bilateral TIAs. He was in sinus rhythm with no valvular pathology, but further investigation revealed that he had a blocked left subclavian artery, a significantly narrowed innominate artery, a blocked origin of his right common carotid artery and a significantly narrowed right subclavian artery. What would you do?

This gentleman underwent replacement of his innominate artery with a Dacron graft up to a relatively normal part of t his right common carotid artery. A bifurcation graft was anastomosed to this to allow reimplantation of the right and left subclavian arteries. No intervention was needed on the left common carotid artery.

Operative technique options

1 Shunt from ascending aorta to peripheral arterial branches

2 CPB with hypothermia and separate arterial return to peripheral arterial branches

3 Circulatory arrest with anterograde cerebral perfusion

4 Circulatory arrest with retrograde cerebral perfusion

5 Circulatory arrest

6 Clamp and go PROBABLY WHAT NOT TO DO!