title: Liberal use of axillary artery cannulation for aortic and complex cardiac surgery.
abstract: OBJECTIVE
  Axillary artery cannulation for cardiopulmonary bypass has been described previously as a safe and reliable technique, with a low risk of atheroemboli, avoidance of malperfusion in aortic dissection and facilitation of selective antegrade cerebral perfusion during hypothermic circulatory arrest. The aim of this study was to document the broad applicability of axillary cannulation and its associated morbidity and identify where it was not possible to use planned axillary cannulation.
  
  
  METHODS
  A retrospective review of a single surgeon's 10-year experience of axillary cannulation using the side-graft technique in 184 consecutive patients (age 22-92 years) in aortic and complex cardiac surgery from July 2002 to June 2012.
  
  
  RESULTS
  There were no intraoperative deaths and no major complications related to axillary artery use. There were six postoperative deaths unrelated to axillary artery cannulation. Six patients (3.3%) had minor complications as a direct result of axillary cannulation including seroma, haematoma, chronic pain and pectoralis major muscle atrophy. There were 10 cases where planned axillary cannulation was abandoned, due to inadequate size of the axillary artery in 8 patients and axillary artery dissection and morbid obesity in 1 patient each.
  
  
  CONCLUSIONS
  Axillary artery cannulation is an ideal arterial inflow site in cases where the ascending aorta is unsuitable as it is safe, reliable and reduces the risks of atheroembolization and malperfusion. Major complications are rare with this meticulous technique and it is our standard practice in complex cardiac and aortic surgery.
authors: Department of Cardiothoracic Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia. laurafong12@gmail.com
authors: Laura S
authors: LS
authors: Fong
authors: Levi
authors: L
authors: Bassin
authors: Manu N
authors: MN
authors: Mathur
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery*; D001366:Axillary Artery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D055815:Young Adult
keywords: Aneurysm; Aortic aneurysm/surgery; Axillary artery; Cardiopulmonary bypass/methods; Dissection