Aortoiliac Dissection Due to Aortic Cannulation

Reinke, Robert T.; Harris, Ronald M.; Klein, Arvin J.; Daily, Pat O.

doi:10.1016/s0003-4975(10)64360-3

Cited by 20 publications

(4 citation statements)

References 15 publications

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“…the possibility of retrograde aortic dissection can be avoided if cannulation of the ascending aorta is employed. Although serious complications such as antegrade aortic dissection (Reinke et al .• 1974;Williams et al .• 1974), pseudoaneurysm formation (Flick et al .• 1971). and cerebral hemorrhage (Kulkarni.…”

Section: Preventionmentioning

confidence: 99%

Retrograde aortic dissection during cardiopulmonary bypass

Eugene

Aronow

Stemmer

1981

Clinical Cardiology

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Summary: Femoral artery perfusion for cardiopulmonary bypass is still employed for reoperation, procedures involving the thoracic aorta, and partial bypass in critical patients. Retrograde aortic dissection is the most significant complication of femoral perfusion. The reported incidence is from 0.6% to 14% with a mortality of 66%. Most of the deaths occurred in patients in whom the dissection was not recognized, or in whom the dissection was recognized but not treated appropriately. Our experience with retrograde dissection totals six patients of 640 (0.9%) in whom femoral inflow was used. Four of the six patients survived the dissection. Sudden increase in extracorporeal line pressure shortly after beginning cardiopulmonary bypass associated with decreased venous return, dampened radial arterial pressure, and the abrupt appearance of a bluish, bulging ascending aorta establishes the diagnosis. Survival is enhanced if cardiopulmonary bypass is promptly discontinued, aortic cannulation established, and bypass reinstituted with the induction of profound hypothermia. Circulatory arrest may then be employed to repair the false passage. In this series the proposed operation was completed in all six patients.

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Section: Preventionmentioning

confidence: 99%

Retrograde aortic dissection during cardiopulmonary bypass

Eugene

Aronow

Stemmer

1981

Clinical Cardiology

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“…The reported complications of direct cannulation of the ascending aorta include acute aortic dissection (Salama and Blesovsky, 1970;Reinke et al, 1974;Williams et al, 1974), excessive haemorrhage from the cannulation site necessitating re-operation (Gerbode et al, 1968), and carotid hyperperfusion causing fatal brain damage (Kulkarni, 1968;Krous et al, 1973). Some postperfusion deaths, especially in children, may be due to inadequate aortic arch perfusion, as suggested by Parker (1969).…”

Section: Discussionmentioning

confidence: 99%

Delayed non-mycotic false aneurysm of ascending aortic cannulation site.

Soorae¹,

Cleland²,

O'Kane³

1977

Thorax

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. (1977). Thorax, 32,[743][744][745][746][747][748] Delayed non-mycotic false aneurysm of ascending aortic cannulation site. Two cases of delayed non-mycotic false aneurysm arising from the ascending aortic cannulation site, presenting one-and-a-half years and seven years after cardiopulmonary bypass, are described. These two cases represent an incidence of 0O12% of this complication. Repair using profound hypothermia and circulatory arrest with femoral artery and femoral vein cannulation for cardiopulmonary bypass is recommended. The advantages and complications of aortic cannulation are discussed and recommendations to minimise the complications of cannulation are made. The clinical presentation and diagnosis of non-mycotic false aneurysms arising from the aortic cannulation site are described. In addition one delayed and two early cases of non-mycotic cannulation site false aneurysms previously published are analysed. Surgeons should be alert to the possibility of this complication in all patients who have had aortic cannulation for cardiopulmonary bypass even in ithe distant past. Unexpected symptoms such as constant anterior chest pain, dysphagia, hoarseness, and increasing widening of the superior mediastinum on the chest radiograph warrant prompt investigation.Delayed non-mycotic false aneurysm arising from the ascending aortic cannulation site is a rare complication of this technique for arterial return in cardiopulmonary bypass, and only one case has been reported previously (Williams et al., 1976 Table). Cannulation and decannulation were carried out uneventfully and the sternotomy wound healed satisfactorily. The postoperative progress was uncomplicated and he was discharged from hospital two weeks after the operation. He was seen regularly in the outpatient department and within six months he was working a 12-hour day on his farm. However, he remained in atrial fibrillation and 10 months later he underwent an unsuccessful attempt at DC cardioversion. During this procedure a small burn was produced over one of the sternal suture wires at the level of the manubriosternal junction, possibly due to inappropriate contact with the electrode. This ultimately resulted in a sinus in which the sternal wire could be easily palpated. This sinus was excised and the sternal wire removed. Histological examination showed a foreign-body reaction with chronic inflammatory cells but culture from the area was sterile.The patient was readmitted to hospital in February 1971 with a fluctuant swelling in the upper third of the sternotomy scar at the site of the previous sinus. This produced serosanguinous fluid when incised, but no organisms were cultured from the fluid. As he had a low-grade pyrexia, 743 on 3 April 2019 by guest. Protected by copyright.

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“…Nevertheless recent reports indicate that fatal complications, both immediate and late, may occur. Immediate complications include carotid hypoperfusion (Parker, 1969;Magilligan et al, 1972) or hyperperfusion (Krous, Mansfield, and Sauvage, 1973), acute aortic dissection (Salama and Blesovsky, 1970;Reinke et al, 1974;Williams, Suwansirikul, and Engelman, 1974), and entrance of the cannula into one of the arch branches or the left ventricle (Magner, 1971).…”

Section: Case Reportmentioning

confidence: 99%