right axillary and left femoral artery perfusion for repair of ... · of pseudoaneurysm both to the...
TRANSCRIPT
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