Right subclavian to brachial artery dissection after neck cannulation for extracorporeal life support in a newborn

We present a patient with a distal arterial dissection after extracorporeal life support (ECLS) cannula placement. A preterm boy with severe pulmonary hypertension, secondary to probable premature closure of the ductus arteriosus, was placed on venoarterial extracorporeal life support utilizing his right internal jugular vein and his right carotid artery. Post-procedure echocardiogram (ECHO) confirmed correct placement, however after the child was routinely repositioned, the arterial cannula was noted to have advanced into his right subclavian artery. The cannula was repositioned back to the innominate artery, but a bilateral duplex revealed an arterial dissection extending from the right distal subclavian artery to the mid brachial artery. Serial duplex exams during ECLS revealed no propagation of the dissection. At decannulation no repair was performed and subsequent duplex exams show stable flow with no distal obstruction