title: Cannulation of the axillary artery with a side graft reduces morbidity.
abstract: BACKGROUND
  The axillary artery is our preferred arterial cannulation site when the ascending aorta cannot be cannulated. Previously, we cannulated the artery directly; now we use a side graft. The purposes of this study were to (1) investigate cannulation-related morbidity and (2) determine whether use of a side graft reduces it.
  
  
  METHODS
  From January 1993 to January 2001, 392 patients underwent 399 axillary artery cannulations. Indications included calcified ascending aorta (129, 32%), ascending aortic aneurysm (115, 29%), type I aortic dissection (85, 21%), cardiac reoperation (70, 18%), and calcified femoral artery (26, 6%). The axillary artery was cannulated directly in 212 (53%) and with a side graft in 187 (47%). Comparisons of cannulation-related morbidity between the direct cannulation and side graft groups were made overall and after both adjusting and matching for propensity score.
  
  
  RESULTS
  Cannulation-related morbidity was infrequent, with brachial plexus injury in 7 (1.8%), axillary artery damage in 7 (1.8%), aortic dissection in 3 (0.8%), and arm ischemia in 3 (0.8%). Only 4 of 187 (2.1%) occurred in the side graft group, versus 16 of 212 (7.0%) with direct cannulation (p = 0.03). After propensity adjustment, the odds ratio for reduction of risk of cannulation-related morbidity with use of a side graft was 0.15 (p = 0.002).
  
  
  CONCLUSIONS
  Use of the axillary artery as inflow for cardiopulmonary bypass is associated with low morbidity. However, cannulation with a side graft was associated with less cannulation-related morbidity than direct cannulation. Routine use of a side graft is recommended whenever axillary artery cannulation is indicated.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery and Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. sabikj@ccf.org
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Sabik
authors.forename: Hassan
authors.initials: H
authors.lastname: Nemeh
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Lytle
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.forename: A Marc
authors.initials: AM
authors.lastname: Gillinov
authors.forename: Jeevanantham
authors.initials: J
authors.lastname: Rajeswaran
authors.forename: Delos M
authors.initials: DM
authors.lastname: Cosgrove
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001366:Axillary Artery; D001807:Blood Vessel Prosthesis; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications