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

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

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

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.

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)

PATIENT POSITION

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)

• 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

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

THANK YOU FOR YOUR

ATTENTION