Axillary artery cannulation in type a aortic dissection operations

Neri, Eugénio; Massetti, Massimo; Capannini, Gianni; Carone, Enrico; Tucci, Enrico; Diciolla, Francesco; Prifti, Edvin; Sassi, Carlo

doi:10.1016/s0022-5223(99)70223-0

Cited by 156 publications

(104 citation statements)

References 9 publications

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“…Kano et al have used left axillary arterial perfusion with fairly good results, 89) although a small sized artery may cause an inadequate perfusion rate in some cases. The axillary artery is directly cannulated, 90,91) or a vascular graft is anastomosed to the axillary artery for interposition. 89,92) In either manner, care should be taken on procedure-related limitation and complications.…”

Section: Perfusion Routementioning

confidence: 99%

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Orihashi¹

2012

Annals of Vascular Diseases

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Despite improved outcomes of acute type A aortic dissection (AAAD), many patients die at the moment of onset, and hospital mortality is still high. This article reviews the latest literature to seek the best possible way to optimize outcomes. Delayed diagnosis is caused by variation in or absence of typical symptoms, especially in patients with neurological symptoms. Misdiagnosis as acute myocardial infarction is another problem. Improved awareness by physicians is needed. On arrival, quick admission to the OR is desirable, followed by assessment with transesophageal echocardiography, and malperfusion already exists or newly develops in the OR; thus, timely diagnosis without delay with multimodality assessment is important. Although endovascular therapy is promising, careful introduction is mandatory so as not to cause complications. While various routes are used for the systemic perfusion, not a single route is perfect, and careful monitoring is essential. Surgical treatment on octogenarians is increasingly performed and produces better outcomes than conservative therapy. Complications are not rare, and consent from the family is essential. Prevention of AAAD is another important issue because more patients die at its onset than in the following treatment. In addition to hereditary diseases, including bicuspid aortic valve disease, the management of blood pressure is important.Keywords: aortic dissection, malperfusion, complication, echocardiography A cute type A aortic dissection (AAAD) not only causes sudden death at the time of onset but leads to various life-threatening complications. In spite of improved diagnostic imaging and surgical strategies, in-hospital mortality is still high, and patients who have survived often suffer from sequelae that make subsequent quality of life poor. This article is aimed to review the latest literature and ideas to seek the best possible way to minimize undesirable results.Various complications of AAAD caused by separation of the aortic wall to outer and inner layers are summarized as three categories: 1) aortic rupture due to disruption of the outer layer; 2) malperfusion caused by the inner layer, that is, the intimal flap; and 3) aortic regurgitation by a deformed aortic valve, leading to acute heart failure. Approximately 20% of patients instantaneously die due to aortic rupture, 1) and 1 to 2% of the remaining patients die every hour unless appropriately treated. 2) Although surgical outcomes are gradually improving, in-hospital mortality of surgical patients (repair on the aortic root to the arch) in 2009 was as high as around 10%, according to the Japanese database. 3) For the further improvement of outcomes, problems should be solved in each of preonset, pre-hospital, and in-hospital stages. In this review, the latter two stages are discussed first, since most of the literature focuses on these stages. After that, the issue of pre-onset stage, i.e., prevention is discussed. DelayeD DiagnosisIn consideration of the natural history of AAAD, the "chain of onset-to-sur...

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Section: Perfusion Routementioning

confidence: 99%

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Orihashi¹

2012

Annals of Vascular Diseases

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“…A experiência inicial tem sido positiva, em pequenas séries 60,61 , mas sua eficácia e segurança ainda necessitam ser comprovadas.…”

Section: Dissecções Agudas Da Aortaunclassified

Diretrizes para a cirurgia das doenças da aorta

Albuquerque¹,

Palma²,

Braile³

et al. 2004

Arq. Bras. Cardiol.

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“…In recent years, several surgeons have preferred axillary artery cannulation to prevent complications such as cerebral complications and malperfusion. 6,10,11) When 80 mmHg in four patients due to the onset of cardiac tamponade. One of these patients had been transferred from the emergency center to the operating room after undergoing resuscitation, which included endotracheal intubation and cardiac massage.…”

Section: Discussionmentioning

confidence: 97%

“…During this study period, transapical aortic cannulation was performed in 6 of the 26 cases of type A aortic dissection. However, in the compared with femoral artery cannulation, axillary artery cannulation is considered to be much safer and more useful, 6,10,11) but greater surgical skill is required to expose the axillary artery than the femoral artery; moreover, the lack of speed and convenience involved in the procedure are disadvantages when using a side graft for axillary artery cannulation compared with femoral artery cannulation. In addition, during axillary artery cannulation, problems such as cerebral ischemia and ischemia of the upper extremities can occur; thus, it may not be useful in all cases.…”

Section: Intraoperative Parameter(s) (Table 2)mentioning

confidence: 99%

Direct and Transapical Central Cannulation for Acute Type A Aortic Dissection

Wada

Matsumura

Minematsu

et al. 2014

Annals of Vascular Diseases

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Objective: The choice of cannulation site for the treatment of acute Stanford type A aortic dissection is much debated. We believe that central cannulation is quick to perform, easy to use, and safe to manage acute type A aortic dissection. Materials and Methods: We retrospectively investigated 26 cases of acute aortic dissection performed using two different central cannulation methods between April 2011 and March 2012. Direct ascending aortic cannulation was performed using the Seldinger technique in 20 patients, and transapical ascending aortic cannulation was performed in six patients in whom puncture was difficult. Results: Patients were 21-86 years old (mean age, 67 years). The surgical techniques used to treat aortic dissection were hemiarch repair in 21 patients and total arch replacement in 5 patients. The mean length of surgery was 393 min. One death (3.8%) was attributed to intestinal ischemia. Conclusion: During surgery for acute aortic dissection, central cannulation using either transapical or direct puncture can be performed quickly and safely, and satisfactory short-term outcomes can be obtained. Because acute aortic dissection can present with various conditions, there is no single perfect surgical or cannulation method; therefore, the choice of surgical procedure should be individualized for each patient.

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Axillary artery cannulation in type a aortic dissection operations

Abstract: In patients with type A aortic dissection in whom femoral arteries are acutely or chronically diseased, axillary artery cannulation represents a safe and effective means of providing arterial inflow during cardiopulmonary bypass.

Cited by 156 publications

References 9 publications

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Diretrizes para a cirurgia das doenças da aorta

Direct and Transapical Central Cannulation for Acute Type A Aortic Dissection

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