Gelatin-sealed branched knitted Dacron grafts (Gelseal^®, Vascutek, UK) were implanted in nine patients for surgical reconstruction of the toal aortic arch. Subjects included Stanford A type acute aortic dessection in five, distal aortic arch aneurysm in three, and aneurysm of the ascending aorta and aortic arch associated with aortic valve stenosis in one patient. There was no hospital death and a good postoperative course was obtained. This graft was soft, pliable and very useful for replacement of the aortic arch especially in emergency cases. However, intensive follow-up is necessary because it dilated about 20% in diameter one month after surgery.

We report a case of successful graft replacement of the total aortic arch using selective cerebral perfusion for recurrent distal aortic arch aneurysm (DAAA). A 72-year-old man who had a history of patch aortoplasty for saccular DAAA was admitted to our hospital. Computed tomography and digital subtraction angiography showed recurrent saccular DAAA and coronary angiography revealed 90% stenosis of the first diagonal branch, resulting in a diagnosis of recurrent DAAA with coronary artery stenosis. A graft replacement of the total aortic arch with the aid of selective cerebral perfusion and coronary artery bypass grafting to the first diagonal branch was carried out. Postoperatively, he had no cerebral complications. One year after the operation, he had an operation for an abdominal aortic aneurysm. The patient is now leading a normal life.