[Arterial Anastomosis( Aorta, Middle Artery, Dissected Vessels, and Artificial Vessels)]

Ascending aortic replacement is a basic procedure in aortic surgery. The crucial factor is the anastomosis method, including the anastomosis site formation. The anastomosis method is usually completely different between true aneurysms and acute aortic dissection because of the difference in the fragility of the aorta. It is necessary to prepare a surgical strategy well preoperatively, such as whether to perform the anastomosis under aortic clamping or by the open distal method, the order of anastomosis, the type of prosthesis, and whether to use a one-piece or two-piece prosthesis. In recent years, advances in surgical adhesives, extracorporeal circulation, and anastomosis methods have improved the surgical outcomes of aortic aneurysms. To further enhance the outcomes, it is desirable to improve the outcomes in shaggy aortic cases with many atheromas, very elderly patients, and patients with extensive aneurysms.