Gerdes A, Joubert-Hübner E, Esders K, Sievers H H
Department of Cardiac Surgery, Medical University of Lübeck, Germany.
Ann Thorac Surg. 2000 May;69(5):1425-30. doi: 10.1016/s0003-4975(00)01137-1.
Performing subclavian artery cannulation in patients with an atherosclerotic ascending aorta or acute aortic dissection is of growing interest. To increase knowledge about pressure and flow distribution in the arch vessels, we investigated the in vitro perfusion characteristics in right subclavian artery cannulation.
Pressures and flow rates in the arch vessels of an aortic arch model were measured during perfusion through the right subclavian artery with different geometries and varying flow rates. Flow visualization was performed by laser light.
In normal subclavian artery geometries, pressure and flow showed a significant increase in only the right common carotid artery (8 mm Hg and 25.5 mL/min, respectively, at 5.5 L/min pump flow). In cases of 50% stenosis at the right subclavian artery origin, a reduction of pressure and flow (6 mm Hg and 22.5 mL/min, respectively, at 5.5 L/min pump flow) in the right carotid artery caused by a suction effect was observed.
Right subclavian artery cannulation provides a valuable alternative for ascending aortic cannulation, enabling nearly balanced arch vessel perfusion. Stenosis at the right subclavian artery origin carries the potential risk of slightly reduced perfusion of the right common carotid artery with questionable clinical relevance.
在患有动脉粥样硬化性升主动脉或急性主动脉夹层的患者中进行锁骨下动脉插管越来越受到关注。为了增加对主动脉弓血管压力和血流分布的了解，我们研究了右锁骨下动脉插管的体外灌注特征。
在通过具有不同几何形状和不同流速的右锁骨下动脉进行灌注期间，测量主动脉弓模型的弓血管中的压力和流速。通过激光进行血流可视化。
在正常锁骨下动脉几何形状中，仅右颈总动脉的压力和血流显著增加（在泵流速为5.5 L/min时，分别为8 mmHg和25.5 mL/min）。在右锁骨下动脉起始处有50%狭窄的情况下，观察到由于抽吸效应导致右颈动脉压力和血流降低（在泵流速为5.5 L/min时，分别为6 mmHg和22.5 mL/min）。
右锁骨下动脉插管为升主动脉插管提供了一种有价值的替代方法，可实现几乎平衡的弓血管灌注。右锁骨下动脉起始处的狭窄存在右颈总动脉灌注略有减少的潜在风险，其临床相关性尚不确定。
