Triple ultrasonography for iatrogenic acute aortic dissection caused by axillary arterial perfusion

Iatrogenic aortic dissection caused by axillary arterial cannulation or perfusion becomes a fatal complication of cardiopulmonary bypass when surgeons do not recognize it in the surgical field of view immediately during surgery. Therefore, we routinely monitor the aorta using 'triple ultrasonography' during cardiovascular surgery. An 85-year-old woman underwent partial arch replacement for chronic type A aortic dissection. During cardiopulmonary bypass, acute aortic dissection was observed in the aortic arch from the right axillary artery on real-time transoesophageal echocardiography. Epiaortic and neck surface ultrasonography detected malperfusion of the carotid artery. During femoral arterial perfusion, the patient was rescued with partial aortic replacement. Axillary artery cannulation is useful for cardiopulmonary bypass but confers a risk of iatrogenic aortic dissection that cannot be confirmed by surgeons surgically. The transoesophageal echocardiography can guard the aorta while systemic perfusion is initiated. Furthermore, epiaortic and neck surface echography can be incorporated to transoesophageal echocardiography. Triple ultrasonography allows for the detection of iatrogenic aortic dissection.