title: Cannulation of the axillary artery: the decision between direct cannulation and cannulation via side graft.
abstract: BACKGROUND
  The axillary artery has emerged as promising alternative cannulation site when the ascending aorta is unsuitable for cannulation. However, in order to minimize vascular injury, the decision to cannulate the artery directly or via graft has to be considered carefully.
  
  
  METHODS
  Seventy patients underwent axillary artery cannulation during a two-year period. Indications for operation were acute aortic dissection type A in 25(36 %), ascending aortic or arch aneurysm in 32 (46 %), redo surgery in 6 (9 %), and severely atherosclerotic aorta in 3 (4.3 %) patients. Depending on the diameter of the vessel and the rigidity of the wall, the artery was either cannulated directly or via an 8-mm prosthetic Dacron graft.
  
  
  RESULTS
  Direct cannulation was performed in 46 patients (66 %) and cannulation via graft in the remaining 24 patients (34 %). The complication rate associated with axillary artery cannulation was 3.8 %. These two patients developed retrograde type A dissection and further dissection into the descending aorta caused by forceful insertion of a 20-French cannula in a very elastic and small artery.
  
  
  CONCLUSIONS
  Cannulation of the axillary artery is an attractive approach with a wide indication spectrum. However, the decision to cannulate directly or via graft should be based on the diameter and elasticity of the vessel, to minimize the complications of vascular injury and subsequent dissection.
authors.affiliation: Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria. t9204604@hotmail.com
authors.forename: T
authors.initials: T
authors.lastname: Fleck
authors.forename: M
authors.initials: M
authors.lastname: Ehrlich
authors.forename: M
authors.initials: M
authors.lastname: Czerny
authors.forename: D
authors.initials: D
authors.lastname: Hutschala
authors.forename: E
authors.initials: E
authors.lastname: Tschernko
authors.forename: P
authors.initials: P
authors.lastname: Mares
authors.forename: E
authors.initials: E
authors.lastname: Wolner
authors.forename: M
authors.initials: M
authors.lastname: Grabenwoger
mesh_terms: D000328:Adult; D000368:Aged; D001366:Axillary Artery; D006348:Cardiac Surgical Procedures; D002404:Catheterization / Q000379:methods*; D000075202:Contraindications; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D008297:Male; D008875:Middle Aged