Left axillary artery perfusion in surgery of type A aortic dissection

A left axillary artery perfusion instead of a femoral perfusion has the benefit of avoiding false lumen perfusion and atheroembolization into the brain, which is caused by retrograde perfusion in type A aortic dissection surgery. We performed type A aortic dissection surgery using the left axillary artery perfusion technique and reviewed this method.

From April 2002 to January 2004, 8 patients with a mean age of 70 years (48 to 81), underwent axillary artery cannulation with a side graft technique in type A aortic dissection operations. Six patients had acute type A and 2 had chronic type A dissections. The surgical procedures were ascending aortic replacement in 5, hemiarch replacement in 2, and total arch replacement in 1.

In all patients, a cardiopulmonary bypass was established through the left axillary perfusion. There were no operative deaths and no hospital deaths. All patients were able to avoid cerebral vascular accidents. One patient required a femoro-femoro bypass on the 10th postoperative day because of malperfusion of the left leg, which occurred suddenly. Postoperative hemorrhaging requiring resternotomy occurred in 2 patients.

A left axillary artery perfusion is safe and useful for arterial inflow for type A aortic dissection surgery.