HE REPAIR OF TYPE-A aortic dissection often requires alternative sites for arterial cannulation for cardiopulmonary bypass (CPB). The risks of cannulation of the femoral artery for the institution of CPB are well known and include retrograde perfusion of the false lumen with potential worsening of the dissection with compromise of organ perfusion, and retrograde embolization. Some techniques, including axillary artery, 1 transapical aortic, 2 and central aorta cannulation, have been described to minimize this complication.3 Some of these techniques require more time and may not be appropriate for all patients. Monitoring the adequacy of cerebral perfusion is of vital importance in all aortic surgical cases and even more whenever the femoral artery is used for CPB. Different methods have been described, including bilateral radial arterial monitoring in addition to transesophageal echocardiographic (TEE) imaging of the descending aorta, 4 right radial artery with left femoral artery monitoring, 5 cerebral oximetric monitoring using nearinfrared spectroscopy, 6,7 transcranial Doppler ultrasonography, 8 ophthalmic artery Doppler ultrasonography, 9 and color-flow Doppler transcutaneous carotid artery ultrasound imaging.10 The authors describe a case of chronic type-A dissection requiring surgical repair in which axillary artery cannulation for the institution of CPB was impossible, requiring femoral artery cannulation. They illustrate a method to quantify carotid artery flow velocity and monitor for intraoperative cerebral malperfusion using transcutaneous Doppler ultrasound of the carotid arteries.