Monograft reconstruction of all the major aortic arch trunks.

Male aged 56 years, a smoker of 60 cigarettes daily, with multifocal disease, presented with vertigo, headaches, syncopal crises and intermittent claudication in both lower extremities. Angiography revealed pre-occlusive stenosis at the origin of the innominate artery, a significant degree of stenosis at the origin of the left common carotid and occlusion of the left subclavicular artery with steal syndrome as well as injury to the aortoiliac system. Revascularisation of all the branches of the aortic arch concomitantly was achieved with the technically simple monograft method using only one Dacron double velour 8 mm prosthesis, restoring circulation to both the cerebral and upper extremities without postoperative complications. Eight years later the subjective clinical findings have remained unchanged. Angiography revealed good function of the graft and subjectively the patient remains in satisfactory condition.