Direct cannulation of the brachiocephalic artery in acute aortic dissection: A report of two cases

ABSTRACT Introduction: The choice of arterial cannulation site during surgery for acute type A aortic dissection varies among institutions. Common options include the femoral artery, axillary artery, apex of the heart, ascending aorta, and brachiocephalic artery. The femoral artery is the most frequently selected site at our institution. Reports on direct arterial cannulation through the brachiocephalic artery for acute aortic dissection are scarce. However, it is a potential option for safe antegrade perfusion. We report two cases where this approach was successfully employed at our institution. Case presentation: The first case involved a 76-year-old female. Computed tomography (CT) revealed an entry site on the left side of the ascending aorta with patency of the false lumen up to the aortic arch. Surgery was performed using brachiocephalic artery cannulation and right atrial drainage to establish cardiopulmonary bypass, followed by ascending aorta replacement. The second case involved a 74-year-old male with pericardial effusion detected on CT. The entry site was identified on the left side of the ascending aorta, with patency of the false lumen up to the aortic arch, along with a 48-mm iliac artery aneurysm. Similar to the first case, axillary or apical cannulation is typically considered appropriate. Surgery was performed using brachiocephalic artery cannulation and right atrial drainage to establish cardiopulmonary bypass, followed by ascending aorta replacement. Discussion: In acute aortic dissection, important conditions for the perfusion route include the ability to achieve rapid cannulation, ensuring antegrade blood flow, and avoiding vascular injury. Severe arteriosclerosis was observed in both cases, with cardiac tamponade and iliac aneurysm noted in case 2. The time from skin incision to cannulation was 15 min in Case 1 and 17 min in Case 2. Conclusions: Direct cannulation of the brachiocephalic artery during surgery for acute aortic dissection is a viable option for reducing the time required to secure arterial access. Therefore, this method may be an effective and safe alternative to antegrade perfusion. Highlights