Carotid artery bypass and supraclavicular subclavian artery cannulation for cerebral malperfusion in aortic dissection

Cerebral malperfusion complicating acute aortic dissection type A is a serious complication associated with markedly increased morbidity, permanent neurological deficit, and mortality. Early cannulation and extended replacement of occluded or dissected carotid arteries is an effective yet underused strategy for improving outcomes in such patients. We present a case of acute aortic dissection type A extending from the aortic root to the right common femoral artery, complicated by an occluded right common carotid artery and a dissected left common carotid artery. The patient was successfully treated with an extensive repair comprising David's procedure, arch repair, frozen elephant trunk implantation, bilateral extended carotid artery bypass and extended left subclavian artery bypass.