Abstract
In this report, we present a case of chronic aortic pseudo-aneurysm due to blunt trauma. The patient was an 81-year-old female who fell off a cliff three years ago. Recently, an aortic pseudo-aneurysm was found on computed tomography (CT). It was located on the proximal portion of the brachiocephalic artery, and had a maximum diameter of 57 mm. As the aortic wall did not have any other abnormalities on CT, we thought reconstruction of the aorta was not needed. However, it was difficult to repair the aorta and the brachiocephalic artery by cross-clamping at the origin of the brachiocephalic artery or side-clamping of the aorta due to the large aneurysm. Therefore, cardiopulmonary bypass with cerebral protection was required. A median sternotomy was performed with an extension to the right side of the neck. To establish extracorporeal circulation, 8-mm vascular prostheses were anastomosed bilaterally to the axillary arteries, and perfusion catheters were inserted bilaterally into the common carotid arteries using a cut-down approach. The right common carotid artery was exposed, and a perfusion catheter was inserted at the neck. The operation was performed under extracorporeal circulation using these four access sites for systemic and cerebral perfusion. Under hypothermic circulatory arrest, the aneurysm and brachiocephalic artery were resected. After side-clamping of the aorta around the defect, systemic perfusion from the left axillary artery was resumed with rewarming. A bifurcated prosthetic graft was anastomosed end-to-side to the aortic defect, and the two graft sections distal to the bifurcation were anastomosed end-to-end to the proximal right common carotid and subclavian arteries. Because of the ingenuity of the perfusion sites, the aorta was preserved and the influence of the extracorporeal circulation was reduced.
