Postoperative peri-axillary seroma following axillary artery cannulation for surgical treatment of acute type A aortic dissection

Abstract

The arterial cannulation site for optimal tissue perfusion and cerebral protection during cardiopulmonary bypass (CPB) for surgical treatment of acute type A aortic dissection remains controversial. Right axillary artery cannulation confers significant advantages, because it provides antegrade arterial perfusion during cardiopulmonary bypass, and allows continuous antegrade cerebral perfusion during hypothermic circulatory arrest, thereby minimizing global cerebral ischemia. However, right axillary artery cannulation has been associated with serious complications, including problems with systemic perfusion during cardiopulmonary bypass, problems with postoperative patency of the artery due to stenosis, thrombosis or dissection, and brachial plexus injury. We herein present the case of a 36-year-old Caucasian man with known Marfan syndrome and acute type A aortic dissection, who had direct right axillary artery cannulation for surgery of the ascending aorta. Postoperatively, the patient developed an axillary perigraft seroma. As this complication has, not, to our knowledge, been reported before in cardiothoracic surgery, we describe this unusual complication and discuss conservative and surgical treatment options.

Innominate vs. Axillary Artery Cannulation in Aortic Surgery: a Systematic Review and Meta- Analysis

“…Nevertheless, IA cannulation was associated with shorter CPB duration ( P =0.004), with a mean time of 173.12± 51.85 minutes and 167.45 ± 54.67 minutes for RAA and IA cannulation, respectively ( P =0.004). This builds on the observed and statistically significant decrease in the CPB time of IA cannulation (202 ± 60 minutes and 196 ± 55 minutes for RAA and IA cannulation, respectively, P =0.727) by Di Eusanio et al [3] , and it is reasonable in view of RAA cannulation as a more technically demanding and time-consuming procedure [6,9] . Though not specifically investigated in this meta-analysis for the setting of thoracic aortic surgery, CPB time has been shown to correlate independently with mortality and morbidity [15,16] .…”

“…Over the past two decades, the ideal site of arterial in-flow has changed [4-6] . Initially, surgeons preferred to use femoral artery as the main arterial cannulation with RCP.…”

Femoral artery cannulation for thoracic aortic surgery: Safe under transesophageal echocardiographic control

“…13,14 Axillary cannulation, although usually well tolerated, has itself been associated with serious complications, including brachial plexus injury, arm ischemia, dissection, and malperfusion during cardiopulmonary bypass. [15][16][17][18] In our large study, we found essentially no local vessel problems such as femoral or iliac artery rupture or dissection. There was a single case of intraoperative descending aortic dissection, but this required no specific treatment.…”

Unilateral Antegrade Cerebral Perfusion during Aortic Arch Repair

“…In the mid-90s, Sabik et al [42] were the first who suggested subclavian artery for arterial cannulation site during thoracic aortic surgery. Subclavian artery cannulation allows to provide antegrade flow during cardiopulmonary bypass, as well as adequate antegrade cerebral perfusion within circulatory arrest [43,44]. The disadvantages of this approach include the impossibility of initiating cardiopulmonary bypass if the artery diameter is too small or has subclavian stenosis or thrombosis [15,43,45].…”