Abstract
A 66 year old heavy smoking male, presented with upper body cyanosis and crescendo transient ischaemic attacks. Computed tomography angiography (A, arrows) revealed near occlusion of the bifurcated graft from the ascending aorta, eight years after zone 0 arch aneurysm exclusion (maintained on aspirin). Native supra-aortic trunks remained patent through collaterals. Bilateral axillary artery revascularisation from the femoral route was accomplished successfully. Cerebral perfusion was achieved by retrograde flow to the right carotid and vertebral arteries (B, arrows) through a complete circle of Willis. The patient is still smoking on dual antiplatelet therapy and remains asymptomatic at five year follow up.Image 1
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