title: Uncertainty of axillary artery perfusion during surgery for acute aortic dissection.
abstract: We treated a patient with acute aortic dissection, which affected the innominate and carotid arteries. Although the true lumen was adequately wide and cerebral malperfusion deemed unlikely, extracorporeal circulation through the femoral artery caused right cerebral malperfusion, and addition of right axillary artery perfusion was ineffective. Several minutes after innominate artery snaring, cerebral blood flow was suddenly restored and the clinical outcome was favorable. Axillary artery perfusion is occasionally unreliable and inevitably demands careful cerebral flow monitoring. A dead-end false lumen in the innominate and carotid arteries requires special caution. A dual-artery perfusion strategy permits innominate artery occlusion as an emergency measure against unexpected malperfusion.
authors.affiliation: Department of Cardiovascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan. Electronic address: imanakaz@saitama-med.ac.jp.
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Imanaka
authors.affiliation: Department of Cardiovascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Kawata
authors.affiliation: Department of Cardiovascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Matsuoka
authors.affiliation: Department of Cardiovascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Yamabi
mesh_terms: D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001366:Axillary Artery; D021721:Balloon Occlusion; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D016122:Brachiocephalic Trunk; D002339:Carotid Arteries; D002560:Cerebrovascular Circulation / Q000502:physiology*; D004630:Emergencies; D005112:Extracorporeal Circulation; D005263:Femoral Artery; D006801:Humans; D008875:Middle Aged; D016896:Treatment Outcome; D035501:Uncertainty