Acute Compartment Syndrome After Axillary Cannulation

Dermatologic complication following axillary cannulation for aortic dissection repair

“…While our patient experienced hyperperfusion syndrome of her RUE, she did not develop the more serious sequelae of compartment syndrome or ischemia and was able to be treated with conservative management with no long‐term effects. The mechanism of hyperperfusion appears to be multifactorial: limb hyperemia due to arterial cannula flow, arterial inflow obstruction, and venous outflow obstruction . Arterial obstruction can be caused by difficulties with construction of the side graft anastomosis, leading to a narrowed axillary artery lumen and preferential flow down the limb .…”

“…We believe that our patient experienced a combination of arterial cannula obstruction, as evidenced by our extremely high arterial line pressures and decreased CPB flows, as well as venous outflow obstruction. Though we initially thought that the presence of the NIBP cuff on the upper arm acted as a protective tourniquet to the underlying skin by preventing fluid extravasation, it is more likely that the cuff contributed to external occlusion of venous return …”

“…Observed and theoretical complications of axillary cannulation include arterial/aortic injury or dissection, small vessel size leading to cannulation problems or inadequate CPB flow, malperfusion, arterial thrombosis, and ipsilateral limb complications (hyperperfusion syndrome, compartment syndrome, ischemia, bleeding, wound infection, and brachial plexus injury). 1,2,8,9 Hyperperfusion syndrome, defined as an edematous limb that is hyperemic and warm to the touch, is one of the most common complications associated with axillary cannulation, 8 whereas thrombosis, wound infection, and brachial plexus injury are plausible but have not been reported. 2 Most complications are seen with direct cannulation of the artery; however, malperfusion and hyperperfusion syndrome are more frequently seen with indirect cannulation.…”

“…The mechanism of hyperperfusion appears to be multifactorial: limb hyperemia due to arterial cannula flow, arterial inflow obstruction, and venous outflow obstruction. 8,9 Arterial obstruction can be caused by difficulties with construction of the side graft anastomosis, leading to a narrowed axillary artery lumen and preferential flow down the limb. 8 Venous obstruction can be caused by bleeding around the cannula into the surrounding tissues thus creating a hematoma, direct compression of the axillary vein by an arterial or venous cannula, deep venous thrombosis, or external compression.…”

Petechial and subcutaneous hemorrhage with blister formations in right upper extremity during cardiopulmonary bypass by axillary artery cannulation

“…Acute compartment syndrome during cardiopulmonary bypass with axillary artery cannulation are a few and rare complication [ 1 ]. In this case, axillary artery cannulation itself might compress the right subclavian vein, and acute compartment syndrome result from transient disorder of venous return.…”