Axillary artery cannulation is a safe, feasible and reliable method for acute type A dissection repair. Axillary artery cannulation has several advantages, including antegrade perfusion of the aorta and selective unilateral perfusion of brain. With increased preference of this technique, problems and complication are more commonly encountered. We report right shoulder dislocation as an unusual complication of axillary cannulation in this letter.

Cardiopulmonary bypass (CPB) via the axillary artery has become an alternative perfusion site, especially in acute aortic dissections.[1] The complications of axillary artery cannulation include embolization, brachial plexus injury, wound hematomas, and infection.[1-3] We report the case of a right shoulder dislocation as an unusual complication of axillary cannulation.

Case Presentation

A 44-year-old man who was referred to our institution because of acute type A dissection was transferred to the operating room. Perfusion via the axillary artery was performed as had been previously described.[1] The axillary artery was exposed via a right subpectoral approach. For right axillary artery access, the patient was placed in the supine position with the upper limb in abduction at 90 degrees and slight external rotation. The Bentall procedure and hemiarch replacement with valved conduit were performed under selective antegrade cerebral perfusion by right axillary artery cannulation.

The postoperative course was satisfactory, and the patient did not need inotropic agents. At 12 hours postoperatively, the patient had paresthesia and muscular weakness involving the right arm. We expected this symptom which was the result of a brachial plexus injury. The patient was discharged on postoperative day eight. The patient's symptoms, right arm paresthesia, and muscular weakness continued until the routine control on the postoperative second month. There were no pathological findings when the nerve and vessels were evaluated. The right shoulder dislocation was found on orthopedic consultation, and his therapy was arranged.

This complication was not directly related to the cannulation of the right axillary artery, but only occurs if the surgeon abducts the arm in surgery. Therefore, the surgeon needs to pay special attention to avoid this complication.

In conclusion, axillary artery cannulation via a right subpectoral axillary approach is a safe, feasible, and reliable method for acute type A dissection repair. Postoperative complications rarely occur. Shoulder dislocation must be kept in mind if the patient complains about weakness and paresthesia of the abducted arm postoperatively.

Declaration of conflicting interests
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Funding
The authors received no financial support for the research and/or authorship of this article.

References

1) Erdil N, Gedik E, Erdil F, Nisanoglu V, Battaloglu B, Ersoy E,O. Early results of surgery for acute type A aortic dissection without using neurocerebral monitoring. Turkish J Thorac Cardiovasc Surg 2010;18:259-63.

2) Schachner T, Nagiller J, Zimmer A, Laufer G, Bonatti J. Technical problems and complications of axillary artery cannulation. Eur J Cardiothorac Surg 2005;27:634-7.

3) Battaloglu B, Erdil N, Nisanoglu V. Axillary artery perfusion in acute type A aortic dissection repair. J Card Surg 2008;23:693-6.