Axilloaxillary cardiopulmonary bypass: a practical alternative to femorofemoral bypass.
BACKGROUND
Peripheral arterial and venous cannulation for cardiopulmonary bypass is used increasingly for patients undergoing minimally invasive cardiac operations, complex reoperations, or repair of aortic dissection or aneurysm, and for patients with extensive arteriosclerotic aortic disease in whom aortic cannulation is a prohibitive embolic risk. The common femoral artery and vein are most commonly used for peripheral cannulation, but these sites may be predisposed to complications, primarily because the femoral vessels are commonly involved with arteriosclerotic disease. We have recently begun to use the axillary artery and axillary vein as alternative cannulation sites, achieving full cardiopulmonary bypass, providing antegrade aortic flow, and avoiding many of the complications associated with other sites.


METHODS
Seven patients with peripheral vascular or aortic disease, or both, prohibiting safe aortic or femoral cannulation underwent cardiopulmonary bypass through axillary artery and axillary vein cannulation, approached through a small single subclavicular incision.


RESULTS
All patients were successfully cannulated and axilloaxillary cardiopulmonary bypass was possible without the need for additional cannulas. All axillary vessels were closed primarily without complication.


CONCLUSIONS
For an expanding population of patients with peripheral vascular and aortic disease, axilloaxillary bypass is a safe and practical alternative to aortic or femoral cannulation.
Bichell
D P
DP
Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Balaguer
J M
JM
Aranki
S F
SF
Couper
G S
GS
Adams
D H
DH
Rizzo
R J
RJ
Collins
J J
JJ
Cohn
L H
LH
D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery; D001021:Aortic Valve / Q000601:surgery; D001161:Arteriosclerosis / Q000150:complications; D001366:Axillary Artery; D001367:Axillary Vein; D006328:Cardiac Catheterization / Q000009:adverse effects; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002406:Catheterization, Peripheral; D002968:Clavicle; D001026:Coronary Artery Bypass; D004617:Embolism / Q000209:etiology; D005260:Female; D005263:Femoral Artery; D005268:Femoral Vein; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000601:surgery; D016491:Peripheral Vascular Diseases / Q000150:complications; D012086:Reoperation; D012307:Risk Factors