title: Axillary versus femoral arterial cannulation in type A acute aortic dissection: evidence from a meta-analysis of comparative studies and adjusted risk estimates.
abstract: OBJECTIVE
  There is a growing perception that femoral arterial cannulation (FAC), by reversing the flow in the thoracoabdominal aorta, may increase the risk of retrograde brain embolization, dissection and organ malperfusion in type A aortic dissection. Axillary artery cannulation (AXC) has been reported to improve operative outcomes by allowing antegrade blood flow. However, FAC still remains largely utilized as a consensus for the routine use of AXC has not yet been reached.
  
  
  METHODS
  A meta-analysis on comparative studies reporting operative outcomes using AXC versus FAC was performed. Pooled weighted incidence rates for end points of interest (both adjusted and unadjusted) have been computed using an inverse variance model.
  
  
  RESULTS
  Overall, a total of 8 studies including 793 patients were analysed (AXC = 396, FAC = 397). AXC was associated with reduced risk for in-hospital mortality [risk ratio (RR): 0.41; 95% confidence interval (CI): 0.29-0.58; P < 0.001] and permanent neurological deficit (PND) (RR: 0.59; 95% CI: 37.-0.93; P = 0.02) when compared with FAC. Pooled adjusted estimates confirmed that AXC was independently associated with a significantly reduced incidence of in-hospital mortality (adjusted OR: 0.54; 95% CI: 0.36-0.82; P = 0.004; I(2) = 57%) and PND (adjusted OR: 0.19; 95%CI: 0.07-0.54; P = 0.002; I(2) = 0%).
  
  
  CONCLUSIONS
  The present meta-analysis demonstrated that AXC is superior to FAC in reducing in-hospital mortality and the incidence of PND in patients operated on for type A acute aortic dissection.
authors: Oxford Heart Centre, Oxford University Hospital, Oxford, UK umberto.benedetto@hotmail.com.
authors: Umberto
authors: U
authors: Benedetto
authors: Oxford Heart Centre, Oxford University Hospital, Oxford, UK.
authors: Haider
authors: H
authors: Mohamed
authors: Oxford Heart Centre, Oxford University Hospital, Oxford, UK.
authors: Piergiusto
authors: P
authors: Vitulli
authors: Oxford Heart Centre, Oxford University Hospital, Oxford, UK.
authors: Mario
authors: M
authors: Petrou
mesh_terms: D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D001366:Axillary Artery / Q000601:surgery; D001927:Brain Diseases / Q000209:etiology; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Aortic dissection; Cardiopulmonary bypass; Outcomes