Is the axillary artery a suitable cannulation site in aortic surgery?
OBJECTIVE
The axillary artery is currently gaining interest as an alternative to femoral artery cannulation in aortic surgery. It was the aim of our study to evaluate the feasibility, safety, and efficacy of axillary artery cannulation in a series of patients undergoing surgery of the ascending aorta and/or the aortic arch.


METHODS
From 1998 to 2002 cardiopulmonary bypass (CPB) perfusion via the axillary artery was intended in 35 patients (28 male), median age 61 (22-77) years. The underlying disease was acute aortic dissection type A in 22/35 (63%), chronic aortic dissection type A in 2/35 (6%), ascending aortic aneurysm in 8/35 (22%), aortic regurgitation after previous ascending aortic replacement in 1/35 (3%), pseudoaneurysm after Bentall operation in 1/35 (3%) and coronary artery disease with severe arteriosclerosis of the aorta in 1/35 (3%).


RESULTS
Conversion to femoral artery or ascending aortic cannulation was necessary in 3 patients. In the other cases, adequate CPB flows of 2.4 l/m2/min were achieved. In 1 case local dissection of the axillary artery occurred after emergency cannulation. No postoperative complications related to axillary artery cannulation, such as upper extremity ischemia, brachial plexus injury, or local wound infection occurred. No new postoperative stroke was noted, hospital mortality was 4/35 (11%) patients.


CONCLUSIONS
Axillary artery cannulation is feasible in the majority of cases and seems to be a safe and effective method in surgery of the ascending aorta and aortic arch. Several disadvantages of femoral artery cannulation and perfusion can be avoided.
Schachner
T
T
Department of Cardiac Surgery, Innsbruck University Hospital, Innsbruck, Austria.
Laufer
G
G
Vertacnik
K
K
Bonaros
N
N
Nagiller
J
J
Bonatti
J
J
D000328:Adult; D000368:Aged; D001014:Aortic Aneurysm / Q000601:surgery; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery; D001366:Axillary Artery; D001783:Blood Flow Velocity; D002303:Cardiac Output, Low / Q000453:epidemiology / Q000209:etiology; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002423:Cause of Death; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000209:etiology; D018579:Patient Selection; D051437:Renal Insufficiency / Q000453:epidemiology / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data; D012449:Safety; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology