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A 77 year old lady is referred with an aneurysm of the root, ascending, and descending aortic aneurysm. In addition to being elderly she also has poor PFTs secondary to a lifelong history of smoking. She has normal coronary arteries. What would you do? Answer
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Her ascending aorta is the thing most likely to kill her at the moment, so a root and ascending aortic replacement up to the arch with a high clamp just proximal to the innominate artery with arch cannulation. The pressure in the right radial artery should be monitored to make sure your clamp does not occlude the origin of this vessel and therefore the brain. In addition an extra anatomical graft to, the left carotid artery should be performed. the origin of the left carotid should then be tied off to prevent endoleaks.
At a second procedure a stent can be placed from the distal aortic arch into the mid descending aorta. It can be seen from the above scans that the distal arch and mid descending aorta are relatively normal.