Total Arch Replacement for Distal Arch Aneurysm with Isolated Left Vertebral Artery;Report of a Case]

We herein present a case of distal aortic arch aneurysm with an isolated left vertebral artery(LVA). In surgery, after establishing cardiopulmonary bypass, the LVA was anastomosed to the left common carotid artery (LCCA) while under moderate hypothermia. Selective cerebral perfusion (SCP) was then initiated by inserting catheters into the brachiocephalic artery( BCA), the LCCA and the left subclavian artery (LSA). The aorta was transected between the BCA and the LCCA, and an open stent graft was deployed into the descending aorta during circulatory arrest. After reconstructing the LSA, LCCA and BCA, the ascending aorta was replaced with a graft. The patient recovered well without any cerebral complications, and computed tomography confirmed the patency of the reconstructed LVA. Regarding the surgical treatment of an aortic arch aneurysm with an isolated LVA, reconstructing the isolated LVA before SCP makes the establishment of SCP straightforward, thereby helping protect the brain from ischemia.