[Total Arch Replacement Using Isolation Technique for Giant Thrombus in Ascending Aorta and Aortic Arch:Report of a...

We report a case of giant thrombus in the ascending aorta and the aortic arch, and our successful treatment. A 52-year-old man was referred to our department for coldness and numbness of the right upper arm and hand for several days. Contrast enhanced computed tomography revealed thrombosis of the right brachial artery and a giant thrombus in the ascending aorta and the aortic arch. Three days after the revascularization of the right upper limb by thrombectomy, we performed total arch replacement with frozen elephant trunk using "isolation technique" which is reported to be useful to prevent embolic stroke during total arch replacement in patients with shaggy aorta. In this technique brain circulation was isolated by establishing selective cerebral perfusion before starting systemic perfusion. Postoperative course was uneventful and no recurrent thrombosis has been observed for a year with anticoagulant therapy. We advocate that this technique is also useful in the presence of thrombus in the ascending aorta and the aortic arch.