Surgical bypass to the left subclavian artery: an extra-anatomical transpleural approach

Abstract

A distal anastomosis in zone 3 is technically demanding during the frozen elephant trunk procedure. Proximalization of the distal anastomosis to zone 2 with subsequent revascularization of the left subclavian artery is an attractive alternative. This video tutorial describes the technique of an extra-anatomical bypass from the aortic prosthesis to the infraclavicular left subclavian (axillary) artery in arch replacement with the distal aortic graft anastomosis in zone 2.

Keywords: Extra-anatomic bypass; Frozen elephant trunk technique; LSA bypass; Left axillary bypass; Left subclavian artery bypass; Subclavian artery; Total arch replacement.