[Operative results of distal aortic arch aneurysms--approaching methods, bypass techniques and complications]

Ten patients underwent repair of aneurysms of the distal aortic arch from 1985 to 1989. There were 8 men and 2 women: aged 58 to 77 (average age 67 years). Seven patients had sacciform aneurysms which were closed by graft patch aortoplasty, and three patients had fusiform aneurysms which were corrected by inserting tube grafts. Seven aneurysms operated since 1988 were approached through median sternotomy continued with left anterior thoracotomy, so called door open method. This approach presented good view of the diseased aorta, and effective for preventing recurrent and phrenic nerve palsy. We used temporary bypass for 4 patients, cardiopulmonary bypass for 4 patients (separate carotid artery perfusion for 2 patients) and centrifugal pump for 2 patients during aortic cross clamping. One patient died intraoperatively from intractable bleeding and two patients died postoperatively from brain damage due to embolic episodes during the operations. These patients showed the severely irregular intima in the aortic arch and were complicated with rupture of the aneurysm or dissections arising from the aneurysms. It should be noticed that careless manipulation of the aortic arch and the brachiocephalic vessels cause cerebral complications in such cases.