Fatal intraoperative dissection of the innominate artery due to perfusion through the right axillary artery

The risk of redo sternotomy is greatly elevated in the setting of aortic proximity to the sternum. Current strategies to avoid catastrophic neurologic injury upon sternal reentry include establishment of peripheral bypass with the use of deep hypothermia and low-flow bypass, both of which may increase risk of neurologic complications. Here, we describe a technique for safe sternal reentry and illustrate its successful use in a patient with close proximity of the aorta to the sternum. With this technique, peripheral cardiopulmonary bypass is established prior to sternal reentry via cannulation of the right axillary artery and femoral vein, and the patient is cooled as the innominate artery is dissected, mobilized, and controlled. This permits the rapid institution of selective antegrade cerebral perfusion (SACP) in the event of aortic injury during sternal reentry. Once the innominate artery is isolated and SACP is initiated, one can safely complete the redo sternotomy, dissection, and distal ascending aortic cross-clamping to continue the operation without interruption in cerebral blood flow. This technique offers a safe approach in select patients and should be utilized in similar high-risk cases.

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Cerebral Protection Using Percutaneous Normothermic Bilateral Antegrade Cerebral Perfusion During Total Arch TEVAR in a Patient With Shaggy Aorta

Journal of Endovascular Therapy ◽

10.1177/1526602820915940 ◽

2020 ◽

Vol 27 (3) ◽

pp. 405-413 ◽

Cited By ~ 2

Author(s):

George Joseph ◽

Rahul Pillai ◽

Vinayak Shukla ◽

Krothapalli S. Babu ◽

Shankar Manickam ◽

...

Keyword(s):

Cerebral Perfusion ◽

Inferior Vena ◽

Axillary Artery ◽

Vena Cava ◽

Innominate Artery ◽

Complete Separation ◽

Balloon Occlusion ◽

Shaggy Aorta ◽

The Right ◽

Antegrade Cerebral Perfusion

Purpose: To report a technique of global cerebral embolic protection (CEP) designed for use during thoracic endovascular aortic repair (TEVAR). Technique: Arterial cannulas are inserted percutaneously in the right axillary artery (12-F) and left common carotid artery (LCCA; 10-F) to provide normothermic antegrade cerebral perfusion during TEVAR with neuromonitoring. Inferior vena cava blood is drawn using a 19-F femoral cannula, filtered, oxygenated, and delivered through independent roller pumps to the arterial cannulas. Static CEP is obtained by balloon occlusion of the 3 aortic arch branches proximally, resulting in complete separation of aortic and cerebral blood flow; static CEP is used during aortic endograft delivery and deployment. Dynamic CEP, obtained by creating flow reversal in the innominate artery and proximal LCCA, is used at all other times. Successful use of this CEP technique is illustrated in a patient with shaggy aorta undergoing fenestrated total arch TEVAR. Conclusion: Percutaneous normothermic bilateral antegrade cerebral perfusion provides effective CEP during TEVAR.

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Successful removal of a central venous catheter misplaced in the right subclavian artery using an intravascular stent: a case report

JA Clinical Reports ◽

10.1186/s40981-021-00418-y ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Haruka Yoshida ◽

Shinichiro Ikemoto ◽

Yasuyuki Tokinaga ◽

Kanako Ejiri ◽

Tomoyuki Kawamata

Keyword(s):

Central Venous Catheter ◽

Subclavian Artery ◽

Axillary Artery ◽

Insertion Site ◽

Venous Catheter ◽

Central Venous ◽

Thrombotic Complications ◽

Successful Removal ◽

Intravascular Stent ◽

The Right

Abstract Background Cannulation of a central venous catheter is sometimes associated with serious complications. When arterial cannulation occurs, attention must be given to removal of a catheter. Case presentation A 62-year-old man was planned for emergency thoracic endovascular aortic repair. After the induction of anesthesia, a central venous catheter was unintentionally inserted into the right subclavian artery. We planned to remove the catheter. Since we considered that surgical repair would be highly invasive for the patient, we decided to remove it using a percutaneous intravascular stent. A stent was inserted through the right axillary artery. The stent was expanded immediately after the catheter was removed. Post-procedural angiography revealed no leakage from the catheter insertion site and no occlusion of the right subclavian and vertebral arteries. There were no obvious hematoma or thrombotic complications. Conclusions A catheter that has been misplaced into the right subclavian artery was safely removed using an intravascular stent.

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Surgical Management of Ascending Aortic Aneurysm and Its Complications

Case Reports in Vascular Medicine ◽

10.1155/2014/102605 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3

Author(s):

Sisira Sran ◽

Manpreet Sran ◽

Nicole Ferguson ◽

Amgad N. Makaryus

Keyword(s):

Open Surgery ◽

Innominate Artery ◽

Aortic Aneurysms ◽

Dacron Graft ◽

Ascending Aortic Aneurysm ◽

Pseudoaneurysm Formation ◽

Aortic Pathology ◽

Surgical Options ◽

The Right ◽

Continuous Bleeding

Ascending aortic aneurysms involving the proximal aortic arch, arising anywhere from the aortic valve to the innominate artery, represent various problems in which open surgery is generally required. Surgical options include excision of the aortic pathology or wrapping the aneurysm shell with an aortic Dacron graft. Intervention using the latter method can lead to extravasation of blood along the suture lines resulting in continuous bleeding within the periprosthetic space. The Cabrol technique was developed as a method for decompression of postoperative leaks by the formation of a conduit system from the periprosthetic space to the right atrium. The coronary ostia are anastomosed to a second graft in an end-to-end fashion, which is then anastomosed to the ascending aortic conduit side to side. The native aorta is then sewn around the prosthesis, hereby creating a shunt to drain anastomotic leakage. This shunt reduces postsurgical risk of pseudoaneurysm formation and normally closes a few days following surgery. We discuss the case of a patient who underwent Cabrol’s variation and six months later was demonstrated to have a patent shunt.

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Unilateral Antegrade Cerebral Perfusion Through the Right Axillary Artery Provides Uniform Flow Distribution to Both Hemispheres of the Brain : A Magnetic Resonance and Histopathological Study in Pigs

Circulation ◽

10.1161/01.cir.100.suppl_2.ii-309 ◽

1999 ◽

Vol 100 (Supplement 2) ◽

pp. II-309-II-315 ◽

Cited By ~ 2

Author(s):

J. Ye ◽

G. Dai ◽

L. N. Ryner ◽

P. Kozlowski ◽

L. Yang ◽

...

Keyword(s):

Magnetic Resonance ◽

Cerebral Perfusion ◽

Axillary Artery ◽

Flow Distribution ◽

Uniform Flow ◽

Histopathological Study ◽

Uniform Flow Distribution ◽

The Right ◽

The Brain ◽

Antegrade Cerebral Perfusion

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Unilateral Antegrade Cerebral Perfusion Through the Right Axillary Artery Provides Uniform Flow Distribution to Both Hemispheres of the Brain

Circulation ◽

10.1161/circ.100.suppl_2.ii-309 ◽

1999 ◽

Vol 100 (suppl_2) ◽

Author(s):

Jian Ye ◽

Guangping Dai ◽

Lawrence N. Ryner ◽

Piotr Kozlowski ◽

Luojia Yang ◽

...

Keyword(s):

Cerebral Blood Volume ◽

Axillary Artery ◽

Circulatory Arrest ◽

Flow Distribution ◽

Mr Perfusion ◽

Mr Perfusion Imaging ◽

Regional Cerebral Blood Volume ◽

The Right ◽

The Brain ◽

Antegrade Cerebral Perfusion

Background —Bilateral antegrade cerebral perfusion (ACP) has decreased in popularity over the past decade because of its complexity and the risk of cerebral embolism. We used magnetic resonance (MR) perfusion imaging to assess flow distribution in both hemispheres of the brain during unilateral ACP through the right carotid artery via a cannula placed in the right axillary artery in conjunction with hypothermic circulatory arrest. Methods and Results —Twelve pigs were randomly exposed to 120 minutes of either bilateral ACP through both carotid arteries (n=6) or unilateral ACP through the right axillary artery (n=6) at pressures of 60 to 65 mm Hg at 15°C, followed by 60 minutes of cardiopulmonary bypass at 37°C. MR perfusion images were acquired every 30 minutes before, during, and after ACP. The brain was perfusion fixed for histopathology. During initial normothermic cardiopulmonary bypass, MR perfusion imaging showed a uniform distribution of flow in the brain. In both the bilateral and unilateral ACP groups, the same pattern was maintained, with an increase in regional cerebral blood volume during ACP and reperfusion. The changes in regional cerebral blood volume and mean transit time were similar in both hemispheres during and after unilateral ACP. No difference was observed between the 2 groups. Histopathology showed normal morphology in all regions of the brain in both groups. Conclusions —Both bilateral ACP and unilateral ACP provide uniform blood distribution to both hemispheres of the brain and preserve normal morphology of the neurons after prolonged hypothermic circulatory arrest.

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Giant Pseudoaneurysm of the Extracranial Vertebral Artery Successfully Treated Using Intraoperative Balloon Catheters

Neurosurgery ◽

10.1227/00006123-199105000-00019 ◽

1991 ◽

Vol 28 (5) ◽

pp. 738-742 ◽

Cited By ~ 7

Author(s):

Junya Hanakita ◽

Hideyuki Suwa ◽

Kiyoshi Nishihara ◽

Koji Iihara ◽

Hiroshi Sakaida

Keyword(s):

Vertebral Artery ◽

Cardiac Pacemaker ◽

Innominate Artery ◽

Anatomical Location ◽

High Morbidity ◽

Vertebrobasilar System ◽

Balloon Catheters ◽

Extracranial Vertebral Artery ◽

The Right ◽

Giant Pseudoaneurysm

Abstract Traumatic pseudoaneurysms of the extracranial vertebral artery rarely occur, because of its deeply protected anatomical location. Because the direct surgical approach has resulted in high morbidity and mortality rates, ligation of the vertebral artery has been adopted, but this can cause an ischemia in the vertebrobasilar system. We report the case of a 73-year-old woman with a huge pseudoaneurysm of the right vertebral artery that occurred after attempted placement of a cardiac pacemaker. The aneurysm was 7 x 7 x 5 cm in size and its neck was situated just distal to the right subclavian artery. Direct surgical repair of the injured vessel and removal of the aneurysm were successfully performed using balloon catheters placed intraoperatively in both the innominate artery and the right vertebral artery.

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PENETRATING TRAUMA OF BRACHIOCEPHALIC ARTERY LESION WITH EMBOLIZATION OF FOREIGN BODY TO RIGHT AXILLARY ARTERY IN PEDIATRIC PATIENT: CASE PRESENTATION AND HIS MANAGEMENT.

10.22541/au.160594392.27795355/v1 ◽

2020 ◽

Author(s):

Luis Zerpa Acosta ◽

Jameel Al Ata ◽

Alfredo Sanchez Gamboa ◽

Elmahi Babikir ◽

Abdullah Al Zahrani ◽

...

Keyword(s):

Pediatric Patients ◽

Surgical Repair ◽

Axillary Artery ◽

Median Sternotomy ◽

Penetrating Trauma ◽

Innominate Artery ◽

Penetrating Injuries ◽

Patient Case ◽

Case Presentation ◽

Great Vessels

ABSTRACT: BACKGROUND: Penetrating injuries of the intrathoracic great vessels are well recognized although uncommon in pediatric patients, management in pediatric patients presents challenges. Surgical repair by median sternotomy is the exposure of choice for accessing innominate artery injuries, but endovascular intervention in being increasingly introduced in the hemodynamically stable

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Stenting for Innominate Artery Stenosis Under Double-Filter Protection of the Anterior and Posterior Circulation via the Right Brachial Artery

Annals of Vascular Surgery ◽

10.1016/j.avsg.2019.07.012 ◽

2020 ◽

Vol 63 ◽

pp. 454.e5-454.e9

Author(s):

Shumpei Onishi ◽

Shigeyuki Sakamoto ◽

Takashi Sadatomo ◽

Kiyoharu Shimizu ◽

Takeshi Hara ◽

...

Keyword(s):

Brachial Artery ◽

Innominate Artery ◽

Posterior Circulation ◽

Artery Stenosis ◽

The Right ◽

Innominate Artery Stenosis

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In thoracic aortic surgery, is innominate artery cannulation a safe and effective alternative to axillary artery cannulation?

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz130 ◽

2019 ◽

Vol 29 (4) ◽

pp. 604-607 ◽

Cited By ~ 3

Author(s):

Amer Harky ◽

Ciaran Grafton-Clarke ◽

Max Hadlett ◽

Emily Shuttleworth

Keyword(s):

Search Strategy ◽

Axillary Artery ◽

Statistical Significance ◽

Aortic Surgery ◽

Case Series ◽

Innominate Artery ◽

Mortality Rates ◽

Thoracic Aortic Surgery ◽

Retrospective Case ◽

Artery Cannulation

Summary A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: in a patient undergoing thoracic aortic surgery, is innominate artery cannulation superior to axillary artery cannulation in terms of postoperative outcomes? Five hundred and thirty-one papers were found using the reported search strategy, of which 5 represented the best evidence to answer the clinical question. A total of 1338 participants were included across the 5 studies. Seven hundred and twenty-two patients were cannulated via the axillary artery and 616 were cannulated via the innominate artery. The included 5 studies were 2 prospective observational cohorts, 2 retrospective case-series analysis and a single-blinded randomized trial. Thirty-day or in-hospital mortality rates were reported in all 5 studies. There were no significant differences in mortality with innominate artery cannulation compared to axillary artery cannulation (P > 0.05), with slightly lower mortality rates in 2 studies, slightly higher mortality rates in 2 and equal in 1 study. Though statistical significance was not demonstrated (P > 0.05), a stroke occurred slightly less frequently in patients receiving innominate artery cannulation compared to axillary artery cannulation in 3 of the 4 studies. Innominate artery cannulation is non-inferior to axillary artery cannulation for thoracic aortic surgery, with a similar level of neuroprotection and is not associated with increased levels of mortality.

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