[A case of total arch graft replacement for distal aortic arch aneurysm developed around the site of graft patch aortoplasty].

A 65-year-old male underwent graft patch aortoplasty for a sacciform aneurysm of the distal aortic arch. Three years later an aneurysm developed around the site of the graft patch aortoplasty, therefore total arch graft replacement was required. The operation was performed through median sternotomy and left supraclavicular incision. The ascending aorta was selected for the aortic perfusion site, avoiding thromboembolism. Selective cerebral perfusion (SCP) was employed to protect the brain. Open distal anastomosis with circulatory arrest offered the optimal operating field despite re-operation. Graft replacement or graft patch aortoplasty has been proposed for the treatment of sacciform aneurysm. However, there is a possibility of aneurysmal change around the site of resected aneurysm. Furthermore because of the development of surgical skill and extracorporeal circulation technique, total arch graft replacement should be considered for the surgical treatment of distal aortic arch aneurysm.