Near-Infrared Spectroscopy-Detected Cerebral Ischemia Resolved by Cannulation of an Axillo-Femoral Graft during Surgical Repair of Type A Aortic Dissection

Abstract

We report the case of a patient who experienced near-infrared spectroscopy (NIRS)-detected transient regional cerebral desaturation during cardiopulmonary bypass for an operation to replace the aortic arch. Prompt institution of additional flow through an axillo-femoral graft was associated with restoration of regional cerebral saturation. The aortic surgery had no neurologic complications. Promptness in detecting and restoring cerebral perfusion appeared crucial in avoiding prolonged cerebral ischemia and reducing the likelihood of adverse neurologic events.

Cannula malposition during antegrade cerebral perfusion for aortic surgery: role of cerebral oximetry

“…Incompleteness of the Circle of Willis due to missing anterior (22%) or left posterior (46%) communicating arteries occurs in 20-30% of the population, 14 which might explain why, in our case and in the cases [10][11][12][13] cited above, flow from the left cerebral circulation was insufficient in perfusing the right side. In some of our other cases, perfusion of the left common carotid artery alone led to improvement in both left and right rSO 2 , thus increasing bilateral brain protection with only left common carotid perfusion (for better exposure) while arch repair was underway.…”

“…10 Unilateral cerebral desaturation during aortic arch surgery that is unrelated to catheter malpositioning during antegrade perfusion can also occur. Agostini et al 11 described a case of type-A aortic dissection repair. Cardiopulmonary bypass was performed with a right axillary artery side graft for arterial inflow.…”