title: Modified perfusion strategy and aortic arch debranching in complicated acute aortic dissection type A: a bridge to definitive endovascular therapy.
abstract: BACKGROUND
  Patients with acute aortic dissection type A (AADA) with aortic arch and supra-aortic vessel involvement have a higher postoperative stroke prevalence and risk of later aortic arch aneurysm development.
  
  
  METHODS
  We report a case of AADA with involvement of supraaortic arteries, complicated by cerebral malperfusion. The ascending aorta was replaced using bilateral antegrade cerebral perfusion through side-grafts attached to both carotid arteries, which were subsequently used as aorto-bi-carotid bypass. One year later, the diameter of aortic arch increased to 5 cm. The endovascular treatment of aortic arch was easily performed since debranching was already almost complete.
  
  
  CONCLUSIONS
  Immediate bilateral carotid artery inflow and subsequent aorto-bi-carotid bypass is a safe way to prevent cerebral malperfusion in the setting of complicated AADA.A potential benefit of this technique is almost complete debranching that facilitates an endovascular arch replacement.
authors: Heart Center Freiburg University, Freiburg, Germany.
authors: Bartosz
authors: B
authors: Rylski
authors: Matthias
authors: M
authors: Siepe
authors: Philipp
authors: P
authors: Blanke
authors: Fabian A
authors: FA
authors: Kari
authors: Joachim
authors: J
authors: Schoellhorn
authors: Friedhelm
authors: F
authors: Beyersdorf
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation; D017536:Carotid Artery, Common / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D057510:Endovascular Procedures; D006801:Humans; D008297:Male; D010477:Perfusion / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome