We report a case of hemolytic anemia caused initially by narrowing of a proximal anastomotic site and subsequently by a kinked prosthetic graft after total aortic arch replacement. A 55-year-old man was diagnosed with acute type A aortic dissection by computed tomography (CT). After total aortic arch replacement, hemolytic anemia and renal dysfunction developed. CT detected narrowing of proximal anastomotic site of the graft. Removing the graft and ascending aortic replacement resolved the signs of hemolytic anemia. However, 50 days after the surgery, severe hemolytic anemia developed again. CT revealed a sharply kinked graft. Total arch replacement was again performed to resect the kinked graft. He was discharged on the 24th postoperative day without hemodialysis.
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