title: Passive Temporary Visceral Shunt from the Axillar Artery as an Adjunct Method during the Open Treatment of Thoracoabdominal Aortic Aneurysm.
abstract: BACKGROUND
  Distal aortic retrograde perfusion systems like the left heart bypass or femoro-femoral extracorporeal circulation are the methods of reference for organ protection during direct approaches to thoracoabdominal aortic aneurysms. The aim of this work was to evaluate the use of a passive arterial shunt to reduce visceral ischemia during aortic operations when occlusive diseases of the iliac arteries make distal aortic retrograde perfusion inappropriate.
  
  
  METHODS
  Ten patients affected by a Crawford type III thoracoabdominal aneurysm (TAA) were operated on between January 2013 and January 2015 with the use of a temporary shunt inserted onto the left axillar artery that allows visceral perfusion immediately after the aorta is opened. The operation was performed after a single dose of heparin (50 UI/kg). The sera lactate levels were measured 2 hr after the last aortic clamp was removed and compared with those obtained from a group of 19 patients operated on for a Crawford type IV TAA during the same period without any arterial shunt.
  
  
  RESULTS
  Neither mortality nor paraplegia occurred. The sera lactate levels were lower in the group of patients operated on for a type III TAA (2.57 ± 1) than for a type IV TAA (3.68 ± 1) (P < 0.01, Student's t-test).
  
  
  CONCLUSIONS
  This method was effective for low mesenteric ischemia, easy to perform, and did not require high doses of anticoagulants.
authors.affiliation: Department of Vascular Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Monnot
authors.affiliation: Department of Vascular Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Marie Melody
authors.initials: MM
authors.lastname: Dusseaux
authors.affiliation: Department of Vascular Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Godier
authors.affiliation: Department of Vascular Surgery, Rouen University Hospital, Rouen, France. Electronic address: didier.plissonnier@chu-rouen.fr.
authors.forename: Didier
authors.initials: D
authors.lastname: Plissonnier
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001366:Axillary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008297:Male; D065666:Mesenteric Ischemia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D008875:Middle Aged; D010477:Perfusion / Q000009:adverse effects / Q000379:methods*; D012039:Regional Blood Flow; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D019344:Lactic Acid; D006493:Heparin