Skip to main content
SpringerLink
Log in

Cannulation of the Extrathoracic Left Common Carotid Artery for Thoracic Aorta Operations Through Left Posterolateral Thoracotomy

  • Papers Presented to the French Vascular Surgery Society
  • Published:
Annals of Vascular Surgery

Abstract

The femoral artery is the usual site of arterial cannulation in thoracic aorta operations through left posterolateral thoracotomy that require cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest (DHCA). The advantage of this perfusion route is in limiting the duration of circulatory arrest. It is associated, however, with the risk of retrograde embolization or, in cases involving aortic dissection, malperfusion of vital organs. To prevent these risks, we have used the extrathoracic left common carotid artery as the perfusion route. From December 1999 to January 2003, we used cannulation of the left extrathoracic common carotid artery in 42 thoracic aorta operations through posterolateral thoracotomy with an open proximal anastomosis technique during DHCA. The indication for thoracic aortic repair was atherosclerotic ulcer in 7 cases, chronic aortic aneurysm in 18, acute type B dissection in 5, and chronic type B dissection in 12. Cannulation of the extrathoracic left common carotid artery was successful in all patients. Postoperative recovery was uneventful, with no cerebrovascular events in all cases. No cannulation-related complications were observed. One patient died from cardiac insufficiency on postoperative day 5. No peripheral neurological deficits (paraplegia or paraparesis) were observed. Postoperative complications included atrial fibrillation in five patients, reoperation to control hemorrhage in six, respiratory insufficiency in nine, and renal insufficiency in six. These results indicate that cannulation of the left extrathoracic common carotid artery is a useful, reliable method for proximal perfusion during CPB in patients undergoing repair of the descending thoracic aorta through left posterolateral thoracotomy. By providing effective perfusion of the brain, this technique can prolong safe DHCA time. Another advantage is the prevention of cerebral emboli, ensuring retrograde flow to the aortic arch.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1.
Figure 2.
Figure 3.

Similar content being viewed by others

References

  1. ES Crawford JS Coselli HJ Safi (1987) ArticleTitlePartial cardiopulmonary bypass, hypothermic circulatory arrest, and posterolateral exposure for thoracic aortic aneurysm operation J. Thorac. Cardiovasc. Surg. 94 824–827 Occurrence Handle1:STN:280:BieD28vjtFI%3D

    CAS  Google Scholar 

  2. NT Kouchoukos BB Daily CK Rokkas et al. (1995) ArticleTitleHypothermic bypass and circulatory arrest for operations on the descending thoracic and thoracoabdominal aorta Ann. Thorac. Surg. 60 67–76 Occurrence Handle10.1016/0003-4975(95)00353-M Occurrence Handle1:STN:280:ByqA387osFQ%3D Occurrence Handle7598623

    Article  CAS  PubMed  Google Scholar 

  3. JF Sabik BW Lytle PM McCarthy DM Cosgrove (1995) ArticleTitleAxillary artery J. Thorac. Cardiovasc. Surg. 109 885–891 Occurrence Handle1:STN:280:ByqB2MjmtVE%3D Occurrence Handle7739248

    CAS  PubMed  Google Scholar 

  4. G Colleti L Torracca GL Canna et al. (1996) ArticleTitleDiagnosis and management of cerebral malperfusion phenomenona during aortic dissection repair by transesophageal Doppler echocardiographic examination J. Card. Surg. 11 355–358 Occurrence Handle8969381

    PubMed  Google Scholar 

  5. DP Bichell JM Balaguer SF Aranki et al. (1997) ArticleTitleAxilloaxillary cardiopulmonary bypass Ann. Thorac. Surg. 64 702–705 Occurrence Handle10.1016/S0003-4975(97)00636-X Occurrence Handle1:STN:280:ByiH2M3ms10%3D Occurrence Handle9307460

    Article  CAS  PubMed  Google Scholar 

  6. PA Schneider ME Rossman S Torem et al. (1988) ArticleTitleTranscranial Doppler in the management of extracranial cerebrovascular disease. Implications in diagnosis and monitoring J. Vasc. Surg. 7 223–231 Occurrence Handle10.1067/mva.1988.avs0070223 Occurrence Handle1:STN:280:BieC3MbjtF0%3D Occurrence Handle2963144

    Article  CAS  PubMed  Google Scholar 

  7. R Aaslid TM Markwalder H Nornes (1982) ArticleTitleNoninvasive transcranial Doppler ultrasound recording of velocity in basal cerebral arteries J. Neurosurg. 57 769–774 Occurrence Handle1:STN:280:BiyD2MfovFw%3D Occurrence Handle7143059

    CAS  PubMed  Google Scholar 

  8. MP Spencer GI Thomas SC Nicholls LR Sauvage (1990) ArticleTitleDetection of middle cerebral artery emboli during carotid endarterectomy using transcranial Doppler ultrasonography Stroke 21 415–423 Occurrence Handle1:STN:280:By%2BC2snosVQ%3D Occurrence Handle2408197

    CAS  PubMed  Google Scholar 

  9. E Neri M Giubbolini F Setacci et al. (2003) ArticleTitleThe retrojugular route: the ideal exposure for carotid endarterectomy performed under locoregional anesthesia Eur. J. Vasc. Endovasc. Surg. 26 250–225 Occurrence Handle10.1053/ejvs.2002.1932 Occurrence Handle1:STN:280:DC%2BD3svkvFSnsg%3D%3D Occurrence Handle14509886

    Article  CAS  PubMed  Google Scholar 

  10. E Neri D Maiza O Coffin M Massetti (1996) ArticleTitleTranspericardial inferior vena caval cannulation in thoracic aorta operations Ann. Thorac. Surg. 62 1208–1209 Occurrence Handle10.1016/0003-4975(96)00599-1 Occurrence Handle1:STN:280:BymH38%2Fkt1E%3D Occurrence Handle8823124

    Article  CAS  PubMed  Google Scholar 

  11. MA Ergin JD Galla SL Lansman et al. (1994) ArticleTitleHypothermic circulatory arrest in operations on the thoracic aorta. Determinants of operative mortality and neurologic outcome J. Thorac. Cardiovasc. Surg. 107 788–797 Occurrence Handle1:STN:280:ByuC2szgsVI%3D Occurrence Handle8127108

    CAS  PubMed  Google Scholar 

  12. S Szentpetery C Crisler GLB Grinnan (1993) ArticleTitleDeep hypothermic arrest and left thoracotomy for repair of difficult thoracic aneurysms Ann. Thorac. Surg. 55 830–833 Occurrence Handle1:STN:280:ByyB387ivFQ%3D Occurrence Handle8466333

    CAS  PubMed  Google Scholar 

  13. Y Okita S Takamoto M Ando et al. (1998) ArticleTitleMortality and cerebral outcome in malades who underwent aortic arch operations using deep hypothermic circulatory arrest with retrograde cerebral perfusion J. Thorac. Cardiovasc. Surg. 115 129–138 Occurrence Handle1:STN:280:DyaK1c7ht1yrtA%3D%3D Occurrence Handle9451056

    CAS  PubMed  Google Scholar 

  14. KM Dossche WJ Morshuis MA Schepens FG Waanders (2000) ArticleTitleBilateral antegrade selective cerebral perfusion during surgery on the proximal thoracic aorta Eur. J. Cardiothorac. Surg. 17 462–467 Occurrence Handle10.1016/S1010-7940(00)00383-3 Occurrence Handle1:STN:280:DC%2BD3c3jslantg%3D%3D Occurrence Handle10773571

    Article  CAS  PubMed  Google Scholar 

  15. T Katoh H Gohra K Hamano et al. (2000) ArticleTitleRight axillary cannulation in the left thoracotomy for thoracic aortic aneurysm Ann. Thorac. Surg. 70 311–313 Occurrence Handle10.1016/S0003-4975(00)01382-5 Occurrence Handle1:STN:280:DC%2BD3cvgvVKhuw%3D%3D Occurrence Handle10921741

    Article  CAS  PubMed  Google Scholar 

  16. Y Moriyama Y Iguro K Hisatomi et al. (2001) ArticleTitleThoracic and thoracoabdominal aneurysm repair under deep hypothermia using subclavian arterial perfusion Ann. Thorac. Surg. 71 29–32 Occurrence Handle10.1016/S0003-4975(00)02237-2 Occurrence Handle1:STN:280:DC%2BD3M7kvFyisQ%3D%3D Occurrence Handle11216763

    Article  CAS  PubMed  Google Scholar 

  17. N Shiiya K Yasuda T Murashita et al. (1997) ArticleTitleTransapical aortic cannulation for hypothermic aortic operation through a left thoracotomy: an alternative to avoid retrograde arterial perfusion J. Thorac. Cardiovasc. Surg. 113 1113–1114 Occurrence Handle1:STN:280:ByiA2cnislA%3D Occurrence Handle9202694

    CAS  PubMed  Google Scholar 

  18. S Westaby T Katsumata (1998) ArticleTitleProximal aortic perfusion for complex arch and descending aortic disease J. Thorac. Cardiovasc. Surg. 115 162–167 Occurrence Handle1:STN:280:DyaK1c7ht1yqsg%3D%3D Occurrence Handle9451060

    CAS  PubMed  Google Scholar 

  19. K Yasuura Y Takagi Y Oohara Y Takami (1999) ArticleTitleTotal body retrograde perfusion during operations on the descending thoracic aorta J. Thorac. Cardiovasc. Surg. 118 559–561 Occurrence Handle1:STN:280:DyaK1MvgtVymsA%3D%3D Occurrence Handle10469976

    CAS  PubMed  Google Scholar 

  20. S Takamoto Y Okita M Ando et al. (1994) ArticleTitleRetrograde cerebral circulation for distal aortic arch surgery through a left thoracotomy J. Card. Surg. 9 576–583 Occurrence Handle1:STN:280:ByqD1cnjtVQ%3D Occurrence Handle7994099

    CAS  PubMed  Google Scholar 

  21. RB Griepp (2001) ArticleTitleCerebral protection during aortic arch surgery J. Thorac. Cardiovasc. Surg. 121 425–427 Occurrence Handle10.1067/mtc.2001.113594 Occurrence Handle1:STN:280:DC%2BD3M3hs1amuw%3D%3D Occurrence Handle11241074

    Article  CAS  PubMed  Google Scholar 

  22. PD Hayes T Vainas S Hartley et al. (2000) ArticleTitleThe Pruitt-lnahara shunt maintains mean middle cerebral artery velocities within 10% of preoperative values during carotid endarterectomy J. Vasc. Surg. 32 299–306 Occurrence Handle10.1067/mva.2000.107565 Occurrence Handle1:STN:280:DC%2BD3cvjvVGlsg%3D%3D Occurrence Handle10917990

    Article  CAS  PubMed  Google Scholar 

  23. JH Halsey HA McDowell S Gelmon RB Morawetz (1989) ArticleTitleBlood velocity in the middle cerebral artery and regional cerebral blood flow during CEA Stroke 20 53–58 Occurrence Handle1:STN:280:BiaC3c7ht1A%3D Occurrence Handle2911835

    CAS  PubMed  Google Scholar 

  24. E Neri M Massetti L Barabesi et al. (2002) ArticleTitleExtrathoracic cannulation of the left common carotid artery in thoracic aorta operations through a left thoracotomy: preliminary experience in 26 patients J. Thorac. Cardiovasc. Surg. 123 901–910 Occurrence Handle10.1067/mtc.2002.121300 Occurrence Handle12019375

    Article  PubMed  Google Scholar 

  25. M Ayad F Vinuela EH Rubinstein (1998) ArticleTitleThe suboccipital carrefour: cervical and vertebral arterial anastomosis Am. J. Neuroradiol. 19 925–931 Occurrence Handle1:STN:280:DyaK1c3ntlGksg%3D%3D Occurrence Handle9613514

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, Caen University Hospital, Caen, France

    Sebastien Veron MD, Dimitrios Buklas MD, Giorgio Pula MD, Antonio Benvenuti MD, Massimo Massetti MD, Federico Bizzarri MD & Carlo Sassi MD

  2. Department of Surgery, Division of Cardiovascular Surgery, University of Siena, Siena, Italy

    Eugenio Neri MD

Authors
  1. Sebastien Veron MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eugenio Neri MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dimitrios Buklas MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giorgio Pula MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Antonio Benvenuti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Massimo Massetti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Federico Bizzarri MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Carlo Sassi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eugenio Neri MD.

About this article

Cite this article

Veron, S., Neri, E., Buklas, D. et al. Cannulation of the Extrathoracic Left Common Carotid Artery for Thoracic Aorta Operations Through Left Posterolateral Thoracotomy. Ann Vasc Surg 18, 677–684 (2004). https://doi.org/10.1007/s10016-004-0108-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10016-004-0108-4

Keywords

Search

Navigation