title: Concomitant reconstruction of arch vessels during repair of aortic dissection.
abstract: Surgery for acute aortic dissection is challenging, especially in cases of cerebral malperfusion. Should we perform only the aortic repair, or should we also reconstruct the arch vessels when they are severely affected by the disease process? Here we present a case of acute aortic dissection with multiple tears that involved the brachiocephalic artery and caused cerebral and right upper-extremity malperfusion. The patient successfully underwent complete replacement of the brachiocephalic artery and the aortic arch during deep hypothermic circulatory arrest, with antegrade cerebral protection. We have found this technique to be safe and reproducible for use in this group of patients.
authors.affiliation: Departments of Cardiac Surgery (Drs. Djukanovic, Jovanovic, Micovic, Nezic, and Vukovic), Vascular Surgery (Dr. Lozuk), and Anesthesiology (Dr. Jagodic), Cardiovascular Institute Dedinje, 11000 Belgrade, Serbia.
authors.forename: Slobodan
authors.initials: S
authors.lastname: Micovic
authors.affiliation: Departments of Cardiac Surgery (Drs. Djukanovic, Jovanovic, Micovic, Nezic, and Vukovic), Vascular Surgery (Dr. Lozuk), and Anesthesiology (Dr. Jagodic), Cardiovascular Institute Dedinje, 11000 Belgrade, Serbia.
authors.forename: Dusko
authors.initials: D
authors.lastname: Nezic
authors.affiliation: Departments of Cardiac Surgery (Drs. Djukanovic, Jovanovic, Micovic, Nezic, and Vukovic), Vascular Surgery (Dr. Lozuk), and Anesthesiology (Dr. Jagodic), Cardiovascular Institute Dedinje, 11000 Belgrade, Serbia.
authors.forename: Petar
authors.initials: P
authors.lastname: Vukovic
authors.affiliation: Departments of Cardiac Surgery (Drs. Djukanovic, Jovanovic, Micovic, Nezic, and Vukovic), Vascular Surgery (Dr. Lozuk), and Anesthesiology (Dr. Jagodic), Cardiovascular Institute Dedinje, 11000 Belgrade, Serbia.
authors.forename: Marko
authors.initials: M
authors.lastname: Jovanovic
authors.affiliation: Departments of Cardiac Surgery (Drs. Djukanovic, Jovanovic, Micovic, Nezic, and Vukovic), Vascular Surgery (Dr. Lozuk), and Anesthesiology (Dr. Jagodic), Cardiovascular Institute Dedinje, 11000 Belgrade, Serbia.
authors.forename: Branko
authors.initials: B
authors.lastname: Lozuk
authors.affiliation: Departments of Cardiac Surgery (Drs. Djukanovic, Jovanovic, Micovic, Nezic, and Vukovic), Vascular Surgery (Dr. Lozuk), and Anesthesiology (Dr. Jagodic), Cardiovascular Institute Dedinje, 11000 Belgrade, Serbia.
authors.forename: Sinisa
authors.initials: S
authors.lastname: Jagodic
authors.affiliation: Departments of Cardiac Surgery (Drs. Djukanovic, Jovanovic, Micovic, Nezic, and Vukovic), Vascular Surgery (Dr. Lozuk), and Anesthesiology (Dr. Jagodic), Cardiovascular Institute Dedinje, 11000 Belgrade, Serbia.
authors.forename: Bosko
authors.initials: B
authors.lastname: Djukanovic
mesh_terms: D000208:Acute Disease; D000328:Adult; D000784:Aortic Dissection / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation; D002560:Cerebrovascular Circulation; D050792:Circulatory Arrest, Deep Hypothermia Induced; D006439:Hemodynamics; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D010477:Perfusion; D019651:Plastic Surgery Procedures; D016896:Treatment Outcome
keywords: Acute disease; aortic aneurysm, dissecting/complications/surgery; aortic arch; brachiocephalic trunk/pathology/surgery; brain ischemia/etiology; cerebral protection; cerebral revascularization/methods; cerebrovascular circulation; extracorporeal circulation; hypothermia, induced; male; malperfusion; middle aged