Incomplete Circle of Willis and Right Axillary Artery Perfusion

Merkkola, Päivi; Tulla, Harri; Ronkainen, Antti; Soppi, Ville; Oksala, Anni; Koivisto, Timo; Hippeläinen, Mikko

doi:10.1016/j.athoracsur.2006.02.034

Cited by 112 publications

(68 citation statements)

References 20 publications

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“…21 On the other hand, a right carotid artery stenosis may lead to cerebral malperfusion in uACP, 22 and according to anatomic studies, 15% of patients present a circle of Willis that is incompletely closed. 23 However, in uACP via the right axillary artery, the right vertebral artery and extracranial collaterals are also perfused. Cerebral malperfusion in uACP has been rare in clinical experience, and several groups have reported impressive results.…”

Section: Differences In Cerebral Protection Strategiesmentioning

confidence: 99%

Cerebral Protection During Surgery for Acute Aortic Dissection Type A

et al. 2011

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on behalf of the GERAADA Investigators Background-Cerebral protection during surgery for acute aortic dissection type A relies on hypothermic circulatory arrest, either alone or in conjunction with cerebral perfusion. Methods and Results-The perioperative and intraoperative conditions of 1558 patients submitted from 44 cardiac surgery centers in German-speaking countries were analyzed. Among patients with acute aortic dissection type A, 355 (22.8%) underwent surgery with hypothermic circulatory arrest alone. In 1115 patients (71.6%), cerebral perfusion was used: Unilateral antegrade cerebral perfusion (ACP) in 628 (40.3%), bilateral ACP in 453 (29.1%), and retrograde perfusion in 34 patients (2.2%). For 88 patients with acute aortic dissection type A (5.6%), no circulatory arrest and arch intervention were reported (cardiopulmonary bypass-only group). End points of the study were 30-day mortality (15.9% overall) and mortality-corrected permanent neurological dysfunction (10.5% overall). The respective values for the cardiopulmonary bypass-only group were 11.4% and 9.1%. Hypothermic circulatory arrest alone resulted in a 30-day mortality rate of 19.4% and a mortality-corrected permanent neurological dysfunction rate of 11.5%, whereas the rates were 13.9% and 10.0%, respectively, for unilateral ACP and 15.9% and 11.0%, respectively, for bilateral ACP. In contrast with the ACP groups, there was a profound increase in mortality when systemic circulatory arrest times exceeded 30 minutes in the hypothermic circulatory arrest group (PϽ0.001). Mortality-corrected permanent neurological dysfunction correlated significantly with perfusion pressure in the ACP groups. Conclusions-This

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Section: Differences In Cerebral Protection Strategiesmentioning

confidence: 99%

Cerebral Protection During Surgery for Acute Aortic Dissection Type A

et al. 2011

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“…İnkomplet willis poligonu prevalansı bazı serilerde %50'ye kadar varan oranlarda tespit edilmiştir ve bu durum serebral perfüzyon bozukluğunun %15'inden sorumlu tutulmaktadır (13,14). Girişim sırasında kontralateral hemisferin desatürasyonu NIRS ve EEG monitörleri ile hızlıca tespit edilerek sol karotid arter ayrıca kanüle edilip ek olarak sol beyin perfüzyonu sağlana-bilir.…”

Section: Discussionunclassified

Intraoperative 16-Channel Electroencephalography and Bilateral Near Infrared Spectroscopy Monitorization in Aortic Surgery

Demir¹,

Aydınlı²,

Ünal³

et al. 2015

Turk J Anaesth Reanim

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Transient neurologic dysfunction is common after aortic surgery. Major causes of postoperative complications followed by cardiac surgery are due to hypoperfusion states such as selective cerebral perfusion, embolic debris during cardiopulmonary bypass and ulcerated plaque emboli originated from carotid arteries. Neurologic complications prolong periods of intensive care unit and hospital stay, worsens quality of life and unfortunately they are an important cause of morbidity. Anaesthesia during a carotid and aortic surgery constitutes of providing adequate brain perfusion pressure, attenuating cerebral metabolism by anaesthetic agents and monitoring the cerebral metabolic supply and demand relationship during the intraoperative period. We present a monitoring approach with an intraoperative 16-channel electroencephalography and bilateral near infrared spectroscopy during redo aneurysm of the sinus of Valsalva surgery. Keywords:Intraoperative neuromonitoring, electroencephalography, aortic surgery, cardiac anaesthesia, near infrared spectroscopy Aort cerrahisi sonrası inme ve geçici nörolojik işlev bozukluğu sık-lığı yüksektir. Açık kalp cerrahisinde perioperatif nörolojik komplikasyonlar; hipoperfüzyon, kalbin tromboembolik artıklarından kaynaklanan emboliler, karotis arterlerden oluşan ülsere plak embolileri, selektif serebral perfüzyonda düşük akım gibi nedenlerden kaynaklanabilir. Gelişen nörolojik komplikasyonlar yoğun bakım ve hastanede kalış süresinde uzama ve morbiditede artışa neden olarak yaşam kalitesini bozabilir. Aort ve karotis cerrahisi anestezisinde hedef beyin perfüzyon basıncının uygun seviyelerde tutulması, serebral metabolik ihtiyaçların anestetik ilaçlarla azaltılması ve bu gereksinim-sunum ilişkisinin intraoperatif dönemde monitörize edilmesini içerir. Bu yazıda, sinüs valsalva anevrizması nedeniyle ikinci kez ameliyat edilen bir hastada intraoperatif 16 kanallı elektroensefalografi ve bilateral near infrared spektroskopi monitörizasyonu kullanımı anlatıldı. 274 GirişA ort cerrahisi sonrası inme sıklığı %2-33, geçici nörolojik işlev bozukluğu sıklığı ise %35'lere varan oranlarda bildirilmektedir (1, 2). Gelişen nörolojik komplikasyonlarla yoğun bakım ve hastanede kalış süresi uzamakta, morbiditede artışa neden olarak yaşam kalitesi bozulmaktadır (3). Açık kalp cerrahisinde perioperatif nörolojik komplikasyonlar; hipoperfüzyon kalbin tromboembolik artıklarından kaynaklanan emboliler, karotis arterlerden oluşan ülsere plak embolileri, selektif serebral perfüzyonda düşük akım gibi nedenlerden kaynaklanabilir. Kardiyopulmoner bypass'ta (KPB) özellikle selektif perfüzyon sırasında serebral kan akımı kollateral dolaşıma bağlı olduğundan uygun perfüzyon basıncının sağlanması önemlidir. Aort ve karotis cerrahisinde anestezi; beyin perfüzyon basıncının uygun seviyelerde tutulması, serebral metabolik ihtiyaçların anestetik ilaçlarla azaltılması ve bu gereksinim-sunum ilişkisinin monitörize edilmesini içerir. Son yıllarda gelişen çeşitli cerrahi stratejiler ve intraoperatif nöromonitörizasyon teknikle...

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“…It has been shown that about 17% of patients were likely to have inadequate perfusion of the left hemisphere with unilateral ASCP because of an incomplete CW (22). In this setting, bilateral ASCP is essential for restoration of perfusion in the left hemisphere.…”

Section: Discussionmentioning

confidence: 99%

Combined CT angiography of the aorta and craniocervical artery: a new imaging protocol for assessment of acute type A aortic dissection

et al. 2017

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Background: To investigate the feasibility of combined computed tomography angiography (CTA) of the aorta and craniocervical artery in acute type A aortic dissection (ATAAD) and the value of incremental craniocervical information.Methods: Combined CTA of head, neck and aorta was performed in patients with suspected aortic dissection and 243 ATAAD patients were analyzed. The image quality and radiation dose were assessed.Valuable craniocervical CTA findings were determined for further surgical analysis.Results: The mean dose-length product (DLP) was 314.11±29.31 mGy.cm. The image quality of craniocervical arteries were 100% diagnostic. Intimal flap involving carotid arteries was detected in 47% of patients, and significant stenosis of true lumen was observed in 60% of common carotid arteries (CCAs).Hypodensity and hypoplasia/occlusion of carotid arteries were also detected and apprised surgeons. The tortuosity of carotid artery was found in 90.9% of patients. Bilateral antegrade selective cerebral perfusion (ASCP) was performed in 21.1% of aortic arch surgery based on 7 hemodynamic variation types of the circle of Willis (CW) determined by cranial CTA information.Conclusions: A combined CTA of head, neck and aorta is feasible with low radiation dose and diagnostic image quality. Incremental information on craniocervical pathology and anatomy may be useful for surgery repair of ATAAD.

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Incomplete Circle of Willis and Right Axillary Artery Perfusion

Cited by 112 publications

References 20 publications

Cerebral Protection During Surgery for Acute Aortic Dissection Type A

Cerebral Protection During Surgery for Acute Aortic Dissection Type A

Intraoperative 16-Channel Electroencephalography and Bilateral Near Infrared Spectroscopy Monitorization in Aortic Surgery

Combined CT angiography of the aorta and craniocervical artery: a new imaging protocol for assessment of acute type A aortic dissection

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