Reply to the Editor

Abstract

We read with interest the article by Orihashi and colleagues 1 concerning axillary artery cannulation pitfalls. We present another possible drawback of axillary artery cannulation. A 69-yearold woman was admitted to the Department of Cardiac Surgery for a type A acute aortic dissection involving the innominate artery. After the usual cannulation of the right axillary artery, with a prosthetic side graft, and the right atrium, cardiopulmonary bypass (CPB) was established with no perfusion problems. At 26 C core temperature, CPB was arrested and the aorta was opened longitudinally. The entry tear was located in the ascending aorta. The innominate artery was clamped, and brain perfusion was begun through the axillary artery cannulation. The dissected aorta was excised, and a 30-mm prosthetic vascular graft was sutured to the distal aortic stump, just proximal to the innominate artery. The vascular graft was clamped, and, always via the axillary artery, systemic perfusion was restored. Near-infrared spectroscopy revealed poor cerebral perfusion, whereas the arterial line inflow pressure increased significantly. Suspecting an obstruction in the axillary artery or innominate artery, we directly cannulated the vascular graft and continued CPB antegradely. This allowed an uneventful completion of the procedure.In aortic dissections involving the innominate artery, there may be a reentry