A shaggy aorta is defined as a very extensive atheromatous disease with diffuse ulcers in combination with fragile and mobile debris, and actual thrombus. Multiple embolisation – resulting in permanent neurological deficits, paraplegia and a large area of mesenteric embolisation – attributed to cholesterol atheromatic mobile plaque caused by shaggy aorta needs to be prevented.

Complete exclusion of the shaggy aorta from the distal aortic arch to the end of the descending aorta was presented in two cases: a 71-year-old male and a 51-year-old male. Successful one-stage repair of the extended aortic arch and descending aorta was performed using an isolated selective cerebral perfusion technique via sternotomy and left anterior thoracotomy.

There were no neurological or embolic events in the present cases. Contrast-enhanced computed tomography showed good reconstruction of the aortic arch and descending aorta. The patients are still being followed up in the outpatient clinic and have shown no atheromatic embolisation for the past 6 years.

The exclusion technique for an entire shaggy aorta followed by one-stage repair of the aortic arch and descending aorta is a durable and feasible operation for preventing atheromatous embolisation.