title: Open Seldinger-Guided Femoral Artery Cannulation Technique for Thoracic Aortic Surgery.
abstract: BACKGROUND
  Debate regarding the optimal cannulation site for aortic surgery continues. We report our recent experience with a simple and rapid open Seldinger-guided technique for femoral cannulation. Aside from speed and simplicity (no need for arterial incision or suture closure), this technique has the added benefit that the distal limb continues to be perfused, as no arterial snare is required.
  
  
  METHODS
  We recently began routinely utilizing an open Seldinger-guided technique for femoral artery cannulation. The artery is exposed surgically but cannulated by guidewire inside a pursestring without arterial incision. The pursestring is simply tied when decannulation is performed. We report our experience with the routine application of this technique from August 2011 to April 2015.
  
  
  RESULTS
  We reviewed the outcome of 337 consecutive peripheral arterial cannulations performed for thoracic aortic surgery (303 femoral, 34 axillary) using the open Seldinger technique. Within the femoral cannulation group, the hospital survival rate was 97% (295 of 303). The survival rate for elective operations was 98% (277 of 283), and 90% (18 of 20) for emergent/urgent. Seldinger-guided femoral cannulation was performed for replacement of the ascending/aortic arch in 88% (266 of 303), the descending thoracic aorta in 7% (22 of 303), and the thoracoabdominal aorta in 5% (15 of 303). There were no instances of intraoperative malperfusion phenomena, arterial dissection, or vascular injury or rupture. No patients had postoperative acute limb ischemia. Local wound complications were observed in 1% of patients (3 of 303). The stroke rate was 1.6% (5 of 303). The same open Seldinger technique was also used without complication in the axillary cannulation group.
  
  
  CONCLUSIONS
  An open Seldinger-guided femoral (or axillary) cannulation technique is quick and easy to perform, with minimal vascular or other complications and extremely low risk of stroke. This technique is recommended for its speed, simplicity, and effectiveness, and for its preservation of distal arterial flow (which is occluded with the traditional arterial incision/arterial snare technique).
authors.affiliation: Aortic Institute, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Tsiouris
authors.affiliation: Aortic Institute, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Sherif
authors.initials: S
authors.lastname: Elkinany
authors.affiliation: Aortic Institute, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Bulat A
authors.initials: BA
authors.lastname: Ziganshin
authors.affiliation: Aortic Institute, Yale University School of Medicine, New Haven, Connecticut. Electronic address: john.elefteriades@yale.edu.
authors.forename: John A
authors.initials: JA
authors.lastname: Elefteriades
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001366:Axillary Artery; D002404:Catheterization / Q000009:adverse effects / Q000379:methods; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D061214:Patient Safety; D012189:Retrospective Studies; D015996:Survival Rate; D013536:Suture Techniques; D019616:Thoracic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome