Aberrant Right Subclavian Artery and Axillary Artery Cannulation in Type A Aortic Dissection Repair

Computational fluid dynamics simulation of the right subclavian artery cannulation

“…Therefore, surgeons should be aware of an aortic anomaly at the time of cannulating the rSCA, especially with acute type A aortic dissection surgery. [12][13][14] Although several authors have described the positive impacts of rSCA cannulation, the mechanism of cerebral protection is still uncertain. Some have tried to evaluate the hemodynamics of the aortic arch when subclavian artery cannulation is used.…”

Axillar or Aortic Cannulation for Aortic Repair in Patients With Stanford A Dissection?

“…Also, Ren and colleagues [5] showed in their analysis of nine nonrandomized studies comprising 715 patients a significantly lower incidence of short-term mortality in patients undergoing aortic repair for type A acute AAD with the use of axillar cannulation compared with femoral cannulation. Interestingly, the axillary cannulation strategy is also technically feasible in patients with aortic arch anomalies, such as aberrant right subclavian artery, because cerebral perfusion can be selectively performed through the additional cannulation of the right common carotid artery [12].…”

Axillary Artery Cannulation in Acute Aortic Dissection: A Word of Caution

“…Kommerell's diverticulum arising from the origin of the ARSA has been related to the development of aneurysms or aortic dissections, and cystic medial necrosis in the diverticular wall has been documented [5]. ARSA complicated by aortic dissection and its successful management, either surgical or interventional, has been reported sporadically [6][7][8]. None of these reports addressed the possibility of missing the ARSA in the case of malperfusion.…”