Dissect out left subclavian artery and control it with umbilical tape
Dissect and retract the left vagus nerve with a vessel loop while identifying and avoiding the phrenic nerve
Being careful not to enter the hematoma, dissect the space between the left subclavian and common carotid arteries, and then circumferentially around the proximal aorta at this level. Blunt finger dissection is often required. Avoid injury to the pulmonary artery, which lies just inferior to the aortic arch. Place an umbilical tape around the aorta for proximal control
Circumferentially dissect and control the descending aorta with umbilical tape, distal to the hematoma. Loop the intervening intercostal arteries with 2-0 silk ligatures
Cross clamp the proximal aorta, left subclavian artery, and descending aorta at the sites dissected. Have anesthesiologist keep track of cross-clamp time
