Total arch replacement in a patient with an unusual vascular anatomy

A 69-year-old man with a history of infectious abdominal aortic aneurysm, which had resulted in removal of the infrarenal abdominal aorta and bilateral axillofemoral bypass 9 years previously, underwent total arch replacement for an aortic arch aneurysm. The patient had the interrupted abdominal aorta and highly atherosclerotic proximal aorta, which precluded the possibility of endovascular stent grafting in combination with arch vessel debranching technique. Therefore, open arch repair was the only treatment option. The operation was successful with his axillofemoral bypass graft being exposed and used for arterial inflow during cardiopulmonary bypass, including integrated selective antegrade cerebral perfusion.