Figure 4.

Intraoperative photograph from the case presented in the clinical vignette demonstrating the proximal end of the ascending aortic Dacron graft mobilized down to the sinotubular junction (STJ) to allow partial clamp placement and create maximal PLZ length. The three arch vessels have been fully mobilized and a vessel loop is seen encircling the left innominate vein. Downward tension on this vessel loop during the arch debranching distal anastomoses facilitates exposure of the arch vessels. LCCA, left common carotid artery; LSCA, left subclavian artery; PLZ, proximal landing zone.