Cannulation of the axillary artery for cardiopulmonary bypass: safeguards and pitfalls.
BACKGROUND
The ascending aorta is the customary site for arterial cannulation for cardiopulmonary bypass. Favorable experience at our institution and elsewhere using axillary artery cannulation in treating type A aortic dissections has caused us to broaden our indications for using this site for arterial cannulation for cardiopulmonary bypass.


METHODS
Medical records, operative notes, and perfusion records were reviewed in all patients in whom the axillary artery was cannulated directly or by a graft for cardiopulmonary bypass from January 1, 2000 through August 30, 2002.


RESULTS
Seventy-five patients underwent axillary artery cannulation during the 32-month interval. Eleven patients had ascending aortic dissections, 20 had extensively diseased ascending aortas, and 44 were individuals undergoing repeat cardiac procedures. The right axillary artery was used in 72 patients and the left in 3. In 16 patients the artery was cannulated directly, and in 59 the arterial cannula was inserted into a prosthetic graft that had been anastomosed to the axillary artery. Axillary artery cannulation was satisfactory in 95% (71 of 75) of the cases in which it was used.


CONCLUSIONS
Cannulation of the axillary artery for cardiopulmonary bypass is a dependable approach for procedures including reoperations, aortic dissections, and extensively diseased ascending aortas.
Sinclair
Michael C
MC
Division of Cardiothoracic Surgery, Department of Surgery, Lehigh Valley Hospital, Allentown, Pennsylvania 18105-1556, USA. sally.lutz@lvh.com
Singer
Raymond L
RL
Manley
Norman J
NJ
Montesano
Ralph M
RM
D000784:Aortic Dissection / Q000150:complications* / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000150:complications* / Q000601:surgery; D001018:Aortic Diseases / Q000150:complications* / Q000601:surgery; D001366:Axillary Artery; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D006331:Heart Diseases / Q000401:mortality / Q000601:surgery*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate