Total arch repair

Aneurysm of the aortic arch (A) requires excision of all the involved arch tissue. Balloon occlusion catheters are used to deliver antegrade cerebral perfusion to the innominate and left carotid arteries (B). Once the proximal and distal graft anastomoses are completed, antegrade flow can be re-established to the rest of the body while the grafts are anastomosed to the head vessels to complete the repair (D).