Treatment of aneurysm of transverse aortic arch.

Although aneurysms involving the aortic arch are usually well localized and amenable to reconstructive operation, the reported results of this form of therapy at this level are not as good as in other portions of the aorta. The difference is due to cerebral and bleeding disturbances associated with cerebral protection techniques. This report describes 30 patients and emphasizes the variability of extent of these lesions and the results of methods employed for cerebral protection, which varied according to extent of disease. The aneurysm involved all but the proximal ascending aorta in one patient and was replaced with a permanent ascending aorta-innominate and left common carotid artery bypass graft. Eight aneurysms were limited to the transverse arch; one was removed with the aid of temporary bypass and seven with cardiopulmonary bypass and separate brachiocephalic normothermic perfusion. Temporary and permanent bypass grafts were used in four patients with lesser involvement. None of these techniques was used in 17 patients who had distal arch involvement. Of the 30 patients, 26 survived and 18 are still alive despite the treatment being spread over a 22 year period. Cerebral complications occurred in 3 patients, two of whom died. These problems were avoided in five patients treated more recently by using lows flows under low pressures. Coagulopathies did not occur. Although the technique of cardiopulmonary bypass, profound hypothermia, and circulatory arrest provides a more convenient and technically simpler method of operation, the disadvantages of coagulopathies with excessive bleeding, pulmonary problems, and lack of consistent cerebral protection argue against its routine use at this time.