Hydrodynamic evaluation of axillary artery perfusion for normal and diseased aorta

Abstract

Axillary artery perfusion is an attractive alternative to reduce the frequency of atheroembolism in extensive atherosclerotic aorta and aortic aneurysms. This study was conducted to evaluate the flow dynamics of axillary artery perfusion. Transparent glass models of a normal aortic arch and an aortic arch aneurysm were used to evaluate hydrodynamic properties. Streamline analysis and distribution of the shear stress was evaluated using a particle image velocity method. In the normal aortic arch model, rapid flow of 80 cm/s from the right axillary artery ran out from the brachiocephalic artery and grazed the lesser curvature of the aortic arch. There was secondary reversed flow in the ascending aorta. Flow from left axillary perfusion went straight to the descending aorta. In the aortic arch aneurysm model, flow from both axillary arteries hit the lesser curvature of the aortic arch and went into the ascending aorta with vortical flow. Distribution of shear stress was high along the jet from the ostium of the brachiocephalic artery and left subclavian artery. Flow in the aortic arch and the ascending aorta was unexpectedly rapid. Special care must be taken when the patient has frail atheroma around arch vessels or the lesser curvature of the aortic arch during axillary artery perfusion.

Effect of atherothrombotic aorta on outcomes of total aortic arch replacement

“…2 However, the perfusion has some problems with regard to the hydrodynamic properties. Minakawa and associates 15 performed a streamline analysis of the right axillary artery perfusion in the aortic arch aneurysm model. The flow jet with rapid velocity strikes on the posterior wall of the ascending aorta and enters the ascending aorta with vortical flow that is unexpectedly rapid.…”

Minimizing Atheromatous Emboli During Arch Surgery With a Sequential Debranching Procedure

“…Advantages of this technique include minimal arch manipulation before circulatory arrest, complete antegrade brain perfusion during circulatory arrest and mainly, cerebral isolation when the laminar flow is lost with CPB initiation; period we believe is at high risk of debris dislodgement within the arch. 4 Furthermore, time of distal circulatory arrest is reduced since solely the distal anastomosis has to be performed before rewarming.…”

Investigation of Risks for Cerebral Embolism Associated With the Hemodynamics of Cardiopulmonary Bypass Cannula: A Numerical Model

“…Numerous studies have proven the significant effect of the hemodynamic properties of the aortic cannula in the generation and distribution of emboli during CPB. Most of the relevant studies investigated the effect of the cannula length or tip design as a main determinant of the flow pattern and flow velocity in the normal and diseased aortic arch. The main variables examined were velocity profiles of the emerging jet from the cannula exit and the drop of jet velocity 5–15 mm downstream of the cannula exit .…”

“…Most of the relevant studies investigated the effect of the cannula length or tip design as a main determinant of the flow pattern and flow velocity in the normal and diseased aortic arch. The main variables examined were velocity profiles of the emerging jet from the cannula exit and the drop of jet velocity 5–15 mm downstream of the cannula exit . Some studies characterized the flow patterns in the aortic arch in the presence of an aortic cannula and consequent wall shear stress as a potential cause for erosion and disruption of embolic atheromatous debris from the aortic arch .…”

“…The main variables examined were velocity profiles of the emerging jet from the cannula exit and the drop of jet velocity 5–15 mm downstream of the cannula exit . Some studies characterized the flow patterns in the aortic arch in the presence of an aortic cannula and consequent wall shear stress as a potential cause for erosion and disruption of embolic atheromatous debris from the aortic arch . Other studies measured emboli distribution between the aortic vessels .…”