Extra-anatomic aortic bypass for repair of type A interrupted aortic arch associated with multiple aneurysms of the collateral circulation

Methods A 22 years old Asian woman with a history of cooling, swelling and pain of upper part of body during exercise, and cyanosis of left arm and both legs. At physical examination, she presented diminished pulses of the left arm and inferior limbs, and high blood pressure in the right arm. A Doppler showed switched flow in the left vertebral artery, and occlusion of left subclavian artery with a refilling through left vertebral and internal thoracic arteries. A thoracic CT scan diagnosed a type A interrupted aortic arch with very large aneurysms of collateral arteries. A single stage extra-anatomic procedure of ascending-to-descending thoracic aorta bypass grafting technique was performed through a median sternotomy and a posterior pericardial approach. Total occluding vascular clamps were used for the distal anastomosis of Dacron graft to the descending thoracic aorta. After the distal anastomosis, the left subclavian artery was ligated at its origin and the descending thoracic aorta, and proximally to the distal anastomosis, to prevent a rupture of the aneurysmatic collateral arteries.