Devised reinforcement of distal stump in total arch replacement using BioGlue

Although thoracic endovascular aortic repair and the open stent-grafting technique have become popular, surgical replacement of the aorta remains the procedure of choice for arch aneurysms. Distal anastomosis in total arch replacement is fraught with danger in the patient with a fragile aortic wall, and can lead to uncontrollable bleeding from the fragile distal stump with existing reinforcement techniques. We describe an easy and secure distal anastomosis reinforcement technique, the "BioGlue rolled sandwich technique", for total arch replacement, which avoids the difficulties of application of BioGlue near the vagus and phrenic nerves.