Brachial artery cannulation for right upper limb ischemia secondary to acute type A aortic dissection

Upper limb ischemia is rare complication of acute type A aortic dissection (ATAAD) with high morbidity and mortality. A 61-year-old male presented following 8-hour onset of severe chest pain and progressive right arm pain with motor-sensory deficits. Computed tomography angiography revealed ATAAD with brachiocephalic and right subclavian artery occlusion. He underwent successful ascending aortic and arch replacement with intraoperative right brachial perfusion and forearm fasciotomy. Proximal limb function was preserved, with gradual distal motor recovery at 5 months under intensive physiotherapy. Dissection-related arterial occlusion may mimic isolated thrombosis on imaging. Prompt central aortic repair with simultaneous intraoperative limb perfusion can preserve limb viability and obviate the need for peripheral revascularization.