fig6

Figure 6. A 4-branched aortic replacement graft is sized to length to prepare for the proximal anastomosis (inset). In this segment, the intercostal arteries feeding the spinal cord are ligated to prevent steal from back-bleeding. Beginning with the difficult-to-rotate posterior portion, we suture the proximal anastomosis transluminally; care is taken to preserve the left recurrent laryngeal nerve. The figure is used with the permission of Baylor College of Medicine.