Baek Wan Ki, Kim Young Sam, Lee Mina, Yoon Yong Han, Kim Joung Taek, Lim Hyun Kyung
Department of Thoracic and Cardiovascular Surgery, College of Medicine, Inha University, Incheon, South Korea.
Department of Thoracic and Cardiovascular Surgery, College of Medicine, Inha University, Incheon, South Korea.
Ann Thorac Surg. 2016 Apr;101(4):1573-4. doi: 10.1016/j.athoracsur.2015.06.054.
Arterial cannulation into the right axillary artery is a commonly adopted perfusion strategy in the treatment of acute aortic dissection. Here we describe our experience of accidentally cannulating the axillary artery in a case of acute aortic dissection with an aberrant right subclavian artery, which was missed preoperatively because its proximal segment was malperfused by the dissection and thereby not enhanced. The rapid hemodynamics collapse at the start of the bypass was reversed by prompt switching to femoral perfusion. Postoperative follow-up computed tomographic angiography revealed a well-perfused right aberrant subclavian artery. Surgeons should be aware of an aortic arch anomaly whenever performing an axillary artery cannulation.
右腋动脉插管是治疗急性主动脉夹层时常用的灌注策略。在此，我们描述了在一例急性主动脉夹层合并右锁骨下动脉异常的病例中意外插管腋动脉的经验，该异常术前未被发现，因为其近端节段被夹层影响灌注不良，因此未强化显影。在体外循环开始时迅速出现的血流动力学崩溃通过迅速转为股动脉灌注而得到逆转。术后随访计算机断层血管造影显示右异常锁骨下动脉灌注良好。外科医生在进行腋动脉插管时应意识到主动脉弓异常情况。
