Intraoperative aortic dissection in a patient with cervical aortic arch

Cervical aortic arch (CAA) is a rare malformation. Herein, we report a 58-year-old female patient diagnosed with left CAA with descending aortic aneurysm. Initially, the descending aorta replacement was planned via left rib-cross thoracotomy. However, because of intraoperative aortic dissection during mobilization, total arch replacement was performed via emergent median sternotomy first. The main body of the synthetic graft was then guided to the left thoracotomy view, and the peripheral anastomosis of the descending aorta was performed. The surgery was successfully completed. The surgical management of CAA remains unstandardized due to its rarity and complex abnormalities. As aortic wall thinning can easily lead to aortic dissection, careful manipulation is required during mobilization.