# Case Report: Improved axillary artery cannulation and extracorporeal membrane oxygenation bridging therapy for cardiogenic shock caused by Marfan syndrome combined with aortic dissection

## TL;DR

This case report describes a modified axillary artery cannulation method for ECMO in a patient with Marfan syndrome and aortic dissection, highlighting its benefits over traditional approaches.

## Contribution

The paper introduces a modified axillary artery cannulation technique for ECMO that reduces complications and improves perfusion in complex cardiovascular cases.

## Key findings

- The modified axillary artery cannulation improved hemodynamics and reduced limb ischemia and infections.
- The technique enhanced cerebral and coronary perfusion, making it a favorable ECMO strategy for high-risk patients.
- Despite ECMO success, the patient's clinical death was due to financial constraints preventing further treatment.

## Abstract

Marfan syndrome (MFS) is a congenital connective tissue disorder whose cardiovascular manifestations primarily affect the ascending aorta, presenting as ascending aortic aneurysm, aortic annulus dilation, aortic valve insufficiency, and aortic dissection (
1). It has a poor prognosis and a high mortality rate.This article reports a case of a patient with MFS and acute Stanford type A aortic dissection. Hematoma compression led to left main coronary artery occlusion, resulting in a large myocardial infarction and severe low cardiac output syndrome. The patient was ultimately treated with a modified axillary artery cannulation for ECMO bridging therapy. This case study focuses on the advantages of ECMO cannulation using an axillary artery bridging graft over traditional peripheral and central cannulation, this cannulation technique offers advantages such as optimized hemodynamics, significantly reduced risk of limb ischemia, fewer infectious complications, and improved cerebral and coronary perfusion, making it one of the more ideal ECMO cannulation strategies. Despite initial success with ECMO support, the patient ultimately abandoned a left ventricular assist device (LVAD) and heart transplantation for financial reasons, resulting in clinical death. This case explores a modified axillary artery cannulation method to achieve antegrade blood flow, avoiding the complications of severe left ventricular afterload and left ventricular dilatation.