1. A Novel Arch-First T-Graft Technique for Extensive Aortic Arch Reconstruction 
Shih-Rong Hsieh, MD, Chien-Chang Chen, MD, Hao-Ji Wei, MD 
The Annals of Thoracic Surgery 
Volume 85, Issue 5, Pages (May 2008)
DOI: /j.athoracsur
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
(A) The right lesser limb of the Y-graft was anastomosed to the brachiocephalic artery using a running 5-0 polypropylene. The brain was perfused both from right axillary (dashed arrow) and femoral arterial inflow (blank arrow). (B) The left common carotid artery was transected with its proximal end oversewn. The right cerebral hemisphere was perfused from right axillary artery (slant-line arrow) or side-branch graft (black arrow). (C) The main trunk of the Y-graft and the left subclavian artery were clamped and the aorta was fully opened. A reversed vascular graft was inserted into the distal aorta and the anastomosis was made with 3-0 polypropylenes. The brain was fully protected with antegraft flow. (D) The reversed vascular graft was pulled out and clamped after evaculating air. Both upper and lower body perfusion restarted. A separate graft was anastomosed to the left subclavian artery. (E) The proximal end of the straight distal aortic graft was anastomosed to the left side-hole of the Y-graft. (F) The left subclavian graft was anastomosed to the straight distal aortic graft. The side-branch stump of the Y-graft was oversewn.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
(A) Completion of anastomoses of the three supra-aortic arteries and the distal aorta from the surgeon's view. (B) Intraoperative view of the completion of the T-graft.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions