Anesthetic Management in Complex Arch Surgery: Debranching of Innominate and Left Common Carotid Arteries in Extensive Aortic Dissection without Cardiopulmonary Bypass

Aortic dissection begins with the formation of a tear in the aortic intima, and it directly exposes an underlying diseased medial layer to the driving force of the intraluminal blood. This blood penetrates the diseased medial layer and cleaves the media longitudinally, thereby dissecting the aortic wall. Herein, we report the case of a 38-year-old woman, who presented with chest pain and dyspnea. After physical examination, laboratory evaluation, echocardiography, and CT–angiography, extensive aortic dissection was diagnosed involving the innominate and left common carotid arteries. Accordingly, the debranching of the aortic arch arteries was performed. During the procedure, the patient was monitored with bilateral regional cerebral tissue oximetry. The patient did not show any signs of complications either in the postoperative period or at postoperative three-month weekly follow-up or at subsequent monthly follow-up for the past year.