Reconstruction of an isolated left vertebral artery during total aortic arch replacement to preserve cerebral perfusion

We describe a technique of reconstruction of an isolated left vertebral artery (ILVA) in total aortic arch replacement. An octogenarian man, with a distal aortic arch aneurysm and whose cerebral perfusion was dependent on an ILVA, underwent total aortic arch replacement combined with an open stent-grafting technique. The ILVA was reconstructed as follows: a short prosthetic graft was first anastomosed to the ILVA in an end-to-side fashion, and the graft was first used as a route for selective cerebral perfusion to the ILVA. Subsequently, the ILVA was reconstructed by means of interposition between the third branch of the four-branched graft and the graft which was anastomosed to the left axillary artery in an extra-anatomical fashion. The patient experienced no neurologic complications. This method is technically easy and useful for maintaining adequate perfusion of an ILVA during its reconstruction while avoiding direct cannulation to it for selective cerebral perfusion.