Cerebral Oxygenation Monitoring Using Near Infrared Spectroscopy for Posttraumatic Innominate Pseudoaneurysmal Surgery

Abstract

Posttraumatic pseudoaneurysm of innominate artery (IA) is uncommon vascular injury. The conventional surgical repair of the IA injury needs profound hypothermia with circulatory arrest, cardiopulmonary bypass with selective perfusion of the right common carotid artery (CCA), or external or internal shunts. However, in case of the presence of contralateral cerebral perfusion to right CCA, it is possible without selective perfusion of the right CCA. We experienced anesthetic management of repairing traumatic pseudoaneurysm of the IA using near infrared spectroscopy (NIRS) without bypass or shunting. Regional cerebral oxygen saturation (rSO2) was continuously measured with NIRS. The back flow test with NIRS to ensure cerebral collateral circulation to the right CCA was performed before IA repair. Right/Left rSO2 were 73/69% and 72/72% at immediately and 3 min after clamp, respectively. The rSO2 were well maintained as baseline level after test-clamping of the IA. Surgical repair was performed without arterial bypass and postoperative course was uneventful. He was discharged without any neurologic complication.