Arterial inflow via an axillary artery graft for the severely atheromatous aorta.
BACKGROUND
Strategy for severe aortic atheromatous disease identified by intraoperative epiaortic ultrasound remains to be determined. We used axillary artery inflow through graft interposition in an attempt to avoid potential embolization.


METHODS
Between July 1995 and June 1997, axillary artery inflow was used in 29 patients. Procedures performed were coronary artery bypass in 21 patients (3 with combined carotid endarterectomy), aortic valve replacement in 2, valve replacement plus coronary artery bypass in 4, atrial septal defect repair in 1, and arch replacement in 1 patient. Fibrillatory arrest was used in 16 patients and circulatory arrest was used in 16 patients for excision of mobile atheroma or arch reconstruction. Antegrade cerebral perfusion through the axillary artery graft was carried out in 11 patients.


RESULTS
There were no brachial neurovascular complications. Two operative deaths occurred. Two patients had operative strokes and 2 more had postoperative stroke, all with resolution at late follow-up. There were no strokes in the subset of patients who had antegrade cerebral perfusion during circulatory arrest.


CONCLUSIONS
The axillary artery is an excellent site for arterial inflow. Furthermore, antegrade cerebral perfusion is easily accomplished during periods of circulatory arrest. Finally, graft placement avoids potential local neurovascular complications.
New England Heart Institute, Catholic Medical Center, Manchester, New Hampshire, USA. baribeau@tiac.net
Y R
YR
Baribeau
B M
BM
Westbrook
D C
DC
Charlesworth
C T
CT
Maloney
D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000601:surgery*; D001366:Axillary Artery / Q000502:physiology*; D002404:Catheterization / Q000295:instrumentation / Q000379:methods; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000209:etiology; D001026:Coronary Artery Bypass / Q000009:adverse effects; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005112:Extracorporeal Circulation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006324:Heart Arrest, Induced; D006344:Heart Septal Defects, Atrial / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000517:prevention & control; D007430:Intraoperative Care; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015996:Survival Rate; D018084:Ultrasonography, Interventional