[HSF] [Fwd: approach to arch and carotid arteries for dissection or multiple aneurysmas]

[Tohru Asai]

Roberto

Great picture! Nice exposure. As long as acute type A dissection, however I
am conservative to replace ascending or hemiarch at most! My indication of
total arch replacement in acute A is followings.
1. presence of intimal tear at the posterior aspect of aortic arch
2. presence of intimal tear at the distal arch beyond the left subclavian
artery. 

I have not replaced total arch when I could not find intimal tear in
ascending or arch (ie retrograde progression of DeBakey III ). Also even if
preop CT showed carotid artery dissected, as long as tear was not present, I
would not radically replace individual branches. Our outcome is fairly good.
I think my approach is pretty much standard of this disease. What do you
think of my indication?
-- 
Tohru Asai
Shiga University of Medical Science
Otsu, Japan



> one of the members asked for this photo, which is my idea how to operate
> a Type A with dissected carotids. This case is a multiple aneurysma
> case, not a Type A.
> Look at the prolongued incision in the neck.