Successful surgical treatment of acute type A aortic dissection complicated with distal arch aneurysm

We report successful surgical treatment in a case of acute type A aortic dissection complicated with distal arch aneurysm. A 74-year-old man presenting with sudden posterior headache was found by enhanced computed tomography to have an ascending aortic dissection (type A) and a distal arch aneurysm of 69 mm in maximal minor axis diameter. We performed total arch replacement, employing a four-branched graft and elephant trunk anastomosis through a median sternotomy. Because the aneurysm was not effectively thrombo-excluded, we performed descending aorta replacement using the elephant trunk through the left fifth intercostal space on the 44th postoperative day. The postoperative course was uneventful.