right axillary and left femoral artery perfusion for repair of ... · of pseudoaneurysm both to the...
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RIGHT AXILLARY AND LEFT FEMORAL ARTERY
PERFUSION FOR REPAIR OF POSTTRAUMATIC
AORTIC ARCH DISRUPTION
THEODOROS KARAISKOS
CARDIOTHORACIC SURGERY DEPT.
“G. PAPANIKOLAOU” GENERAL HOSPITAL
THESSALONIKI, GREECE
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TRAUMATIC AORTIC RUPTURE
• 80% of patients die at the scene of injury due to free rupture &
exsanguination into the chest
• when the mediastinal pleura, adventitia, and sometimes part of the
aortic wall are spared, the victim will have a mediastinal hematoma
of variable size and may survive to reach the hospital
• > 50% succumb to mediastinal hemorrhage over the ensuing week
[Circulation 1958; 17:1086-101]
• descending thoracic aorta at the level of the ligamentum arteriosum,
just distal to the take-off of the left subclavian a.
• Endovascular treatment is the gold standard nowadays
• Alternative – surgical repair with distal circulatory support through
partial left-heart bypass for the aortic repair
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CASE PRESENTATION
• 22 years old male
• motorcycle accident
• transferred to our dept. - 2 days following 1st admission
from local hosp.
• Delayed diagnosis
• Neurologically intact
• Fracture of the left forearm
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CT ANGIO FINDINGS
• traumatic rupture of the aortic istmus, with formation
of pseudoaneurysm both to the superior and inferior
wall of the descending thoracic aorta
• pseudoaneurysm at the superior wall of the aortic
arch is located directly after the origin of the left
subclavian artery
• bilateral pleural effusions, mostly to the left, with
atelectasis of the adjacent lung parenchyma.
• aberrant origin of the left vertebral artery from the
aortic arch between the left common carotid and left
subclavian artery.
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Intubation
• Left sided double lumen
endotracheal tube
Cannulation
• Right axillary and right femoral art
through an 8 mm dacron graft
interposition
• Femoral vein - 19 Fr Bio-Medicus
(Medtronic)
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PATIENT POSITION
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PROCEDURE
• 4th intercostal space
• Blunt dissection of the brachiocephalic branches
• Mobilization of the distal descending aorta
• Centrifugal pump (Biomedicus)
• X-clamp of the brachiocephalic art. & descending Ao
• Opening of the Ao at 18 oC (32 min)
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• Selective antegrade cerebral
perfusion and distal organ
perfusion
• Proximal open aortic repair with
dacron graft (20 mm) interposition
• Distal Ao anastomosis at
rewarming ( 20 mm Dacron graft)
& subclavian art. reanastomisis (8
mm dacron graft interposition)
• Total distal Ao X-clamp time 84
min
• CPB time 2 hrs + 50 min
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CONCLUSION
• Selective antegrade cerebral perfusion through the R. Axillary Art. & simultaneous
Lower-Body perfusion through the Femoral Art. is safe and feasible
• Time consuming
• Excellent protection of the brain, spine & lower body
• Perfect visualization
• Durable repair
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THANK YOU FOR YOUR
ATTENTION