case_images: PMC3563508_01
case_images: Computed tomography (CT) image showing an aneurysm of the sinus of Valsalva and an extended aortic aneurysm, spanning the proximal descending aorta to level of the abdominal aorta.
case_images: 1749-8090-8-23-1.jpg
case_images: PMC3563508_01_1749-8090-8-23-1.jpg
case_images: F1
case_images: Computed tomography (CT) revealed an aneurysm of the sinus of Valsalva and an extensive aortic aneurysm, reaching 67 mm in diameter, spanning the length of the descending aorta to the level of the abdominal aorta (Figure 1).
case_images: Collared graft for aortic arch debranching. The distance from the collar to the distal edge of the graft is 10 cm in length; this part of the graft is inserted into the aorta as a long elephant trunk. Arrow head indicates the collar of the graft.
case_images: 1749-8090-8-23-2.jpg
case_images: PMC3563508_01_1749-8090-8-23-2.jpg
case_images: F2
case_images: Another 14-mm graft (Gelweave, Vascutek Ltd.), acting as the branch graft, was anastomosed to the main-body graft in an end-to-side fashion for eventual connection with the brachiocephalic artery. Another 16 x 8-mm graft (Gelweave, Vascutek Ltd.) was anastomosed to the branch graft for eventual connection with the left common carotid artery and the left axillary artery (Figure 2).
case_images: Schematic of the first operation. Distal anastomosis is accomplished between the polyester flange and the previous graft. Arrow indicates the distal anastomosis site. BCA: brachiocephalic artery; LCCA: left common carotid artery; LSA: left subclavian artery.
case_images: 1749-8090-8-23-3.jpg
case_images: PMC3563508_01_1749-8090-8-23-3.jpg
case_images: F3
case_images: The length of the graft from the flange to the distal edge was 10 cm; this was inserted into the thoracic aorta as a long elephant trunk, and anastomosis was accomplished between the polyester flange and the previous graft (Figure 3).
case_images: Postoperative CT indicating successful aortic reconstruction.
case_images: 1749-8090-8-23-4.jpg
case_images: PMC3563508_01_1749-8090-8-23-4.jpg
case_images: F4
case_images: The patient's postoperative course was uneventful; postoperative CT indicated successful aortic reconstruction (Figure 4).