Aortic arch aneurysm Resection and replacement: protection of the nervous system

A patient with an aortic arch aneurysm, who was submitted to resection and replacement by a prosthetic graft during a 36-minute period of cerebral arterial occlusion at 20° C, and who subsequently died of ischaemic brain damage, is reported. Current methods for protection of the central nervous system from ischaemic damage during operations of this type are reviewed. It is considered that total body perfusion, including all arteries which supply the circle of Willis, with hypothermia as low as 20° C, will provide the safest background to a successful operation.