The cuff technique for reconstructing an isolated left vertebral artery in total arch-replacement surgery

In total arch-replacement surgery, careful attention must be paid to the presence of anomalous arch vessels, because their presence may require surgeons to change the brain-protection strategy during deep hypothermic circulatory arrest and selective cerebral perfusion. The anomaly we most often encounter is an isolated left vertebral artery (ILVA). We describe a case involving a straightforward but physiological way of reconstructing the ILVA in which a cuff is hollowed together with the left subclavian artery.