{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T18:13:51Z","timestamp":1788113631217,"version":"build-2803163510"},"reference-count":3,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T00:00:00Z","timestamp":1788048000000},"content-version":"vor","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Perfusion during aortic arch surgery may be uniquely complicated by atypical vascular anatomy in patients with prior extra-anatomic bypass grafts. We describe a case of compromised circulatory arrest in a 40-year-old male with ACTA2 aortopathy who previously underwent thoracic endovascular aortic repair, complicated by limb ischemia requiring right axillofemoral and femoral-femoral bypass grafts. Twenty-five years later, progressive aortic root enlargement and zone 3 false lumen perfusion prompted staged left carotid-subclavian bypass, followed by mechanical aortic root and arch replacement with frozen elephant trunk. During circulatory arrest, parallel outflow via patent bypasses flooded the operative field, necessitating right femoral arterial control preserving cerebral perfusion and bloodless field. Extra-anatomic bypass grafts may form low-resistance circuits mimicking steal physiology, and distal control including manual compression, graft snaring, clamping, or balloon occlusion should be anticipated. Preoperative recognition of extra-anatomic bypasses therefore enables tailored perfusion strategies to optimize cerebral perfusion and operative conditions.<\/jats:p>","DOI":"10.1093\/jscr\/rjag740","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T11:12:00Z","timestamp":1786101120000},"source":"Crossref","is-referenced-by-count":0,"title":["Atypical perfusion compromising circulatory arrest during mechanical root replacement and aortic arch replacement with frozen elephant trunk in ACTA2 aortopathy"],"prefix":"10.1093","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6682-7670","authenticated-orcid":false,"given":"Durr","family":"Al-Hakim","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of British Columbia , 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9986-0718","authenticated-orcid":false,"given":"Sorush","family":"Rokui","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, University of British Columbia , 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Percy","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, University of British Columbia , 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Price","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, University of British Columbia , 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,30]]},"reference":[{"key":"2026083013182750700_ref1","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1161\/circgenetics.114.000943","article-title":"Aortic disease presentation and outcome associated with ACTA2 mutations","volume":"8","author":"Regalado","year":"2015","journal-title":"Circ Cardiovasc Genet"},{"key":"2026083013182750700_ref2","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.athoracsur.2024.01.021","article-title":"EACTS\/STS guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ","volume":"118","author":"Czerny","year":"2024","journal-title":"Ann Thorac Surg"},{"key":"2026083013182750700_ref3","doi-asserted-by":"publisher","first-page":"91","DOI":"10.3390\/anesthres1020010","article-title":"Enhancing neuroprotection in cardiac and aortic surgeries: a narrative review","volume":"1","author":"Torre","year":"2024","journal-title":"Anesthesia Res"}],"container-title":["Journal of Surgical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2026\/8\/rjag740\/70876823\/rjag740.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2026\/8\/rjag740\/70876823\/rjag740.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T17:18:36Z","timestamp":1788110316000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jscr\/article\/doi\/10.1093\/jscr\/rjag740\/8776156"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":3,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8,4]]}},"URL":"https:\/\/doi.org\/10.1093\/jscr\/rjag740","relation":{},"ISSN":["2042-8812"],"issn-type":[{"value":"2042-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,8]]},"article-number":"rjag740"}}