title: Right axillary arterial perfusion for descending thoracic or thoracoabdominal aortic aneurysm repair with open proximal anastomosis through left thoracotomy.
abstract: BACKGROUND
  We examined the effectiveness of right axillary arterial perfusion through an interposed Dacron graft in the prevention of cerebral embolism or complications related to ascending aortic cannulation in open proximal anastomosis technique of descending thoracic aortic aneurysm (TAA) or thoracoabdominal aortic aneurysm (TAAA) repair under deep hypothermic circulatory arrest through left thoracotomy.
  
  
  METHODS
  Between May 2000 and August 2012, 44 patients underwent TAA or TAAA repair using open proximal technique under DHCA. These patients were divided into two groups for evaluation of the effectiveness of right axillary arterial perfusion. Group A included patients who underwent TAA or TAAA repair with ascending aortic cannulation (n=15). Group B was composed of patients who had TAA or TAAA repair with right axillary arterial perfusion through the interposed Dacron graft (n=29).
  
  
  RESULTS
  Mortality in this series was 4.5% (2 of 44 patients; 1 in each group); wherein, the causes were sepsis due to graft infection and aortic dissection (Stanford type A). The incidence rates of cerebral embolism were 27 % (4 of 15 patients in group A) and 3.4% (1 of 29 patients in group B) (p=0.0392, Fisher's exact test). The rates of complications in relation to the aortic cannulation site (dissection or bleeding) were 13% (2 of 15 patients in group A) and 0% (0 of 25 patients in group B).
  
  
  CONCLUSIONS
  Right axillary perfusion facilitates easy evacuation of air and allows prompt recommencement of upper body circulation. Consequently, it minimizes the risk of cerebral embolism or complications in relation to aortic cannulation through left thoracotomy.
authors.affiliation: Department of Cardiovascular Surgery, Sapporo Central Hospital, South 9 West 10, Chuo-ku, Sapporo, 064-0809, Japan, nobuyosh@sapmed.ac.jp.
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Kawaharada
authors.forename: Toshiro
authors.initials: T
authors.lastname: Ito
authors.forename: Shuichi
authors.initials: S
authors.lastname: Naraoka
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hagiwara
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Koyanagi
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Kurimoto
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Higami
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D000784:Aortic Dissection / Q000601:surgery; D001011:Aorta / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001365:Axilla / Q000098:blood supply*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002404:Catheterization; D050792:Circulatory Arrest, Deep Hypothermia Induced; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology; D013908:Thoracotomy / Q000379:methods; D055815:Young Adult