scholarly journals A modified axillo-femoral perfusion for acute type a aortic dissection accompanied with lower limb malperfusion

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Qianzhen Li ◽  
Liangwan Chen ◽  
Yue Shen ◽  
Jiahui Li ◽  
Yi Dong
Keyword(s):  
Femoral Artery ◽  
Lower Limb ◽  
Axillary Artery ◽  
Type A ◽  
Lower Limbs ◽  
Acute Type ◽  
Ischemic Time ◽  
Aortic Repair ◽  
The Right ◽  
Artery Perfusion

Abstract Background Lower limb malperfusion accompanied with acute type A dissection (AAD) is reported to be an independent predictor for mortality. Timely treatment is required. However, staged approach to restore the perfusion of the ischemic leg before aortic repair has a continuously increase risk of aortic rupture. Aortic repair under isolated axillary artery perfusion also has the risk of prolonging leg ischemia. Here we introduce our experience in performing axillo-femoral perfusion, which is supposed to bring benefits for treating lower limb malperfuison. Methods Thirty patients who suffered AAD accompanied by lower limb ischemia enrolled in our study. All patients received aortic repair as soon as possible using the modified axillo-femoral perfusion approach. The cardiopulmonary bypass and cooling started with the right axillary artery perfusion. Then the femoral artery of the ischemic side was exposed and sewn to a graft connected with another inflow cannula. The rectal temperature was about 31 °C when the femoral perfusion started. The perfusion of the ischemic legs preoperative was estimated after the surgery by the clinical signs, the saturation of the distal-limb, and computed tomography scan. Results Twenty-eight patients got good perfusion of the lower body after the surgery. Two patients received femoral-femoral artery bypass immediately after surgery because of the thrombosis in the right common iliac artery, without further injury. No peripheral vessels damage occurred, and no compartment fasciotomy or amputation needed. One patient died for the sepsis and the subsequent multi organ failure 28 days postoperative. Conclusions The modified axllio-femoral perfusion could restore the lower limbs’ perfusion simultaneously during the aortic surgery without neither delaying dissection repair nor prolonging the ischemic time. It is a simple, but safe and effective technique.

Right Axillary Artery Cannulation for Endovascular Repair of an Acute type a Aortic Dissection

2017 ◽  
Vol 12 (2) ◽  
pp. 140-143 ◽  
Author(s):  
Corbin E. Muetterties ◽  
Jeremy H. Conklin ◽  
G. William Moser ◽  
Grayson H. Wheatley
Keyword(s):  
Aortic Dissection ◽  
Endovascular Repair ◽  
Axillary Artery ◽  
False Lumen ◽  
Type A ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Aortic Repair

We present the case of a 48-year-old woman with an acute type A aortic dissection that was treated with thoracic endovascular aortic repair at our institution. The patient was found to have a focal type A dissection with pericardial effusion but no tamponade physiology and no involvement of the aortic valve or root. We elected to treat the patient's type A aortic dissection with an endovascular stent because of the patient's favorable anatomy and no evidence of neurologic deficits or signs of distal malperfusion. The patient was successfully treated with an abdominal aortic cuff deployed through the axillary artery. An axillary approach was necessary because of the short length of the delivery sheath preventing a transfemoral delivery. At 2-year follow-up, the patient remains free of complications with computed tomography scan revealing complete false lumen thrombosis and a stable endovascular repair. This report demonstrates a case of acute type A aortic dissection successfully treated using thoracic endovascular aortic repair and illustrates the utility of axillary cannulation for precise deployment of stent grafts in the ascending aorta.

Axillary Artery Perfusion in Acute Type A Aortic Dissection Repair

2008 ◽  
Vol 23 (6) ◽  
pp. 693-696 ◽  
Author(s):  
Bektas Battaloglu ◽  
Nevzat Erdil ◽  
Vedat Nisanoglu
Keyword(s):  
Aortic Dissection ◽  
Axillary Artery ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Artery Perfusion

Is Axillary Better Than Femoral Artery Cannulation in Repair of Acute Type A Aortic Dissection?

2019 ◽  
Vol 14 (2) ◽  
pp. 124-133 ◽  
Author(s):  
Eilon Ram ◽  
Yoav Krupik ◽  
Alexander Lipey ◽  
Ami Shinfeld ◽  
Yael Peled ◽  
...  
Keyword(s):  
Renal Failure ◽  
Aortic Dissection ◽  
Femoral Artery ◽  
Operative Mortality ◽  
Axillary Artery ◽  
Type A ◽  
Acute Type ◽  
Complication Rates ◽  
Type A Aortic Dissection ◽  
Artery Cannulation

Objective We compared early and late outcomes of patients who underwent femoral versus axillary artery cannulation for repair of acute type A aortic dissection. Methods Between 2004 and 2017, we retrospectively evaluated the clinical outcomes of 135 consecutive patients who underwent emergency surgery for acute type A aortic dissection repair. Patients were divided into 2 groups: those who underwent femoral ( n = 84) and those who underwent right axillary ( n = 51) artery cannulation. Mean patient age was 63 ± 13 years and 88 (65%) were male. Results Overall operative mortality was 12.6% (axillary 15.7%, femoral 10.7%; P = 0.564). Patients who underwent axillary compared to femoral artery cannulation had a statistically nonsignificant higher operative mortality rate among both stable and unstable patients (13% vs. 6.5%, P = 0.405 and 40% vs. 22.7%, P = 0.818, respectively). While there was no difference in major complication rates, such as stroke, low cardiac output, and surgical revision for bleeding/tamponade, there was a higher incidence of renal failure that required dialysis in patients who underwent axillary cannulation (12% vs. 1%, P = 0.022). Multivariate analysis demonstrated that predictors for the composite endpoint of operative mortality or severe organ malperfusion, such as renal failure or cerebrovascular accident, were hemodynamic instability on admission (OR 3.87; 95% CI, 1.23 to 12.63; P = 0.021), lower preoperative creatinine clearance (OR 0.94; 95% CI, 0.90 to 0.97; P < 0.001); and the use of axillary artery cannulation (OR 4.1; 95% CI, 1.43 to 12.78; P = 0.011). Among those discharged from hospital, the 3-year survival rate was 91% in the axillary group and 87% in the femoral group ( P = 0.772). Conclusions Based on our experience, emergent surgery for both stable and unstable patients with acute type A aortic dissection demonstrated similar survival rates and significantly less renal impairment when using the femoral cannulation approach.

scholarly journals Evaluation of Lower Limb Arteriovenous Diameters in Indoor Soccer Athletes: Arterial Doppler Ultrasound Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Sónia Mateus ◽  
Rui Paulo ◽  
Patrícia Coelho ◽  
Francisco Rodrigues ◽  
Vasco Marques ◽  
...  
Keyword(s):  
Doppler Ultrasound ◽  
Femoral Artery ◽  
Popliteal Artery ◽  
Lower Limb ◽  
Femoral Vein ◽  
Common Femoral Artery ◽  
Lower Limbs ◽  
Popliteal Vein ◽  
Ultrasound Study ◽  
The Right

The purpose of this study was to analyze the arterial and venous diameters of lower limbs in indoor soccer athletes and non-athletes using Doppler ultrasound to identify the differences in the variation of arterial and venous diameters between groups. Additionally, we intended to verify the differences of arterial and venous diameters between the skilled member (right member) and the not skilled member in each group. 74 male volunteers, aged between 19 and 30 years old, were divided in a group of athletes (n = 37, 24 ± 2.7 years, soccer players from national championship), and a group of non-athletes (n = 37, 26 ± 2.83 years). Vascular lower limb was assessed using Doppler ultrasound (Philips HD7 echograph with linear transducer 7–12 MHz). The athletes showed higher diameters of right common femoral artery (p = 0.009; moderate), left common femoral artery (p = 0.005; moderate), right deep femoral artery (p = 0.013; moderate), right popliteal artery (p = 0.003; moderate), and left popliteal artery (p = 0.017; small) than non-athletes. Veins’ diameters were also higher in athletes, specifically the right deep femoral vein (p ≤ 0.001; large), left deep femoral vein (p ≤ 0.001; large), right popliteal vein (p ≤ 0.001; large), and left popliteal vein (p ≤ 0.001; large). Differences were found between the skilled and non-skilled leg in athletes in the popliteal vein (7.68 ± 1.44 mm vs. 7.22 ± 1.09 mm, respectively, p &lt; 0.003). It seems that futsal athletes have superior mean diameters of lower limbs arteries and veins of the deep venous system to non-athletes. Moreover, the veins presented greater dilation, namely of the leg of the skilled lower limb.

Acute Type-A Aortic Dissection with Obstruction of the Right Coronary Artery

2014 ◽  
Vol 17 (4) ◽  
pp. 196
Author(s):  
Erhan Kaya ◽  
Halit Yerebakan ◽  
Daniel Spielman ◽  
Omer Isik ◽  
Cevat Yakut
Keyword(s):  
Coronary Artery ◽  
Aortic Dissection ◽  
Right Coronary Artery ◽  
Type A ◽  
Sudden Onset ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Coronary Syndrome ◽  
Bentall Procedure ◽  
The Right

Occlusion of a coronary artery by an acute type A aortic dissection presents a life-threatening emergency that is rarely seen and easy to misdiagnose. We present the case of a 75-year-old male who experienced sudden onset of severe left-sided chest pain due to an acute type A aortic dissection that obstructed the right coronary artery. Following an initial misdiagnosis of acute coronary syndrome, imaging revealed the presence of an aortic dissection. An emergency modified Bentall procedure was performed, in which the damaged aorta and aortic valve were replaced.

scholarly journals Protease nexin-1 deficiency increases mouse hindlimb neovascularisation following ischemia and accelerates femoral artery perfusion

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sonia Selbonne ◽  
Celina Madjene ◽  
Benjamin Salmon ◽  
Yacine Boulaftali ◽  
Marie-Christine Bouton ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Capillary Density ◽  
Leukocyte Recruitment ◽  
Lower Limbs ◽  
Artery Ligation ◽  
Angiogenic Balance ◽  
Important Player ◽  
Protease Nexin ◽  
Artery Perfusion

AbstractWe previously identified the inhibitory serpin protease nexin-1 (PN-1) as an important player of the angiogenic balance with anti-angiogenic activity in physiological conditions. In the present study, we aimed to determine the role of PN-1 on pathological angiogenesis and particularly in response to ischemia, in the mouse model induced by femoral artery ligation. In wild-type (WT) muscle, we observed an upregulation of PN-1 mRNA and protein after ischemia. Angiography analysis showed that femoral artery perfusion was more rapidly restored in PN-1−/− mice than in WT mice. Moreover, immunohistochemistry showed that capillary density increased following ischemia to a greater extent in PN-1−/− than in WT muscles. Moreover, leukocyte recruitment and IL-6 and MCP-1 levels were also increased in PN-1−/− mice compared to WT after ischemia. This increase was accompanied by a higher overexpression of the growth factor midkine, known to promote leukocyte trafficking and to modulate expression of proinflammatory cytokines. Our results thus suggest that the higher expression of midkine observed in PN-1- deficient mice can increase leukocyte recruitment in response to higher levels of MCP-1, finally driving neoangiogenesis. Thus, PN-1 can limit neovascularisation in pathological conditions, including post-ischemic reperfusion of the lower limbs.

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