title: Challenging management of a complex distal aortic arch pseudoaneurysm following previous aortic dissection repair.
abstract: The primary goals of surgery for acute aortic dissection are to resect or control the intimal flap, prevent distal malperfusion, protect the brain and have a viable patient. However, several technical measures are important to prevent early and late sequalae, including adequate aortic resection, creating a stable anastamotic suture line, appropriate graft measurement and tailoring and completely resecting inciting aortic aneurysms. Utilizing simultaneous sternotomy and thoracotomy incisions, we report the re-operative management of a patient with an expanding distal aortic arch pseudoaneurysm, extending into the left pleural space, superimposed upon severely kinked proximal ascending aortic grafts and an aneurysmal aortic root only 6 months after initial repair.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery,  University of Western Ontario, Lawson Health Research Institute, London, ON,  Canada.
authors.forename: Krista
authors.initials: K
authors.lastname: Moore
authors.forename: Nirmal
authors.initials: N
authors.lastname: Kakani
authors.forename: Michael W A
authors.initials: MW
authors.lastname: Chu
mesh_terms: D000784:Aortic Dissection / Q000601:surgery*; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011474:Prosthesis Design; D012086:Reoperation; D056346:Sternotomy; D013908:Thoracotomy; D016896:Treatment Outcome