[Aortic Arch-descending Aorta Bypass for Intraoperative Lower Body Malperfusion during Chronic Type A Aortic...

We present a case of intraoperative lower body malperfusion in a 55-year-old woman who was undergoing total aortic arch replacement (TAR) for chronic type A aortic dissection. We planned 2-staged operation that consisted of total aortic arch replacement using the elephant trunk technique and thoracic endovascular aneurysm repair. During the 1st surgery, hemodynamic findings after TAR indicated lower body malperfusion, with the blood pressure of the upper body of 127/46 (68) mmHg and that of the lower body of 71/46 (51) mmHg. Transesophageal echocardiography showed narrowing of the true lumen and expansion of the false lumen of the proximal descending aorta. We performed aortic arch-descending aorta bypass using the branch for arterial return of the prosthetic arch graft. After the bypass procedure, lower body malperfusion improved. The postoperative course was uneventful. Extraanatomical aortic arch-descending aorta bypass may be an option for improving intraoperative malperfusion of the lower body due to true lumen narrowing.