[Replacement of distal arch aneurysm: distal hemiarch replacement]

Among thoracic aortic aneurysm, operative result for distal arch aneurysm is poor. Approach auxiliary technique, and operative procedure are still controversial. We noticed that distal arch aneurysm frequently involve anterior lesser curvature of aortic arch, then we have designed "distal hemiarch replacement" that preserve branches of aortic arch and replace lesser curvature of arch sufficiently. Furthermore, we managed to prevent cerebral injury by atheromatous embolism using intraoperative echogram to detect atherosclerosis of aortic arch and the branches. Median approach, selective cerebral perfusion, and distal hemiarch replacement were performed consistently for seven distal arch aneurysm. As the result, all cases recovered without neurological deficit except one ruptured emergency case. Distal hemiarch replacement for distal arch aneurysm enabled sufficient essential removal and reconstruction of the thoracic aorta with minimal invasion. Intraoperative echogram could reduce operative cerebral injury and brought sufficient operative results.