Strategies for selective perfusion of upper and lower body during aortic aneurysm and in the presence of carotid stenosis

In the presence of false lumens in aneurysms and stenosis in neck vessels, the primary goal is to ensure adequate blood flow to the brain. Suitable criteria to select extracorporeal circulation strategies adapted, is to meet the requirements of cerebral protection through the maintenance of either adequate perfusion or sustained protection without complications or compromise.

To plan and manage perfusion strategies for selective perfusion of upper and lower body during repair of aortic arch aneurysm and undetected presence of carotid stenosis.

From December 2006-December 2009, ten patients presented with aortic aneurysm of varied locations, who were operated for aneurysm repair in our centre. Among, these four patients who were suspected to have carotid lesions were selected for strategy A, whereas six patients having no documentation of carotid stenosis were selected for stratergy B.

Strategy A: Two rollers pumps were used for upper and lower body perfusion.

Strategy B: A single roller pump was used to perfuse upper and lower body. A bio flow probe was used to measure the flow through the axillary arterial line.

The use of two roller pump perfusion technique is advantageous in controlling the amount of blood flow to the brain but requires constant vigilance and expertise to avoid cavitation and creation of negative pressure. On the contrary single pump perfusion technique has the advantage of easy setup, use and familiarity but does not provide absolute control over cerebral blood flows.

We found the two methods had equal advantages and disadvantages and the optimal strategy need to plan on a case to case basis, giving priority to patient safety.