Axillary artery and transapical aortic cannulation as an alternative to femoral artery cannulation

Watanabe, Ko; Fukuda, Ikuo; Osaka, Motoo; Imazuru, Tomohiro

doi:10.1016/s1010-7940(03)00076-9

Cited by 16 publications

(16 citation statements)

References 7 publications

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“…In this case, we switched to femoral cannulation, another option would probably be the use of the sidegraft technique in axillary cannulation. Cannulation problems of the axillary artery are described in literature in a range of 1-10% [1,7,8]. A low CPB flow was present in one of our patients after axillary cannulation, and the perfusion was switched to aortic cannulation.…”

Section: Cannulation Problems/low Cpb Flowmentioning

confidence: 68%

“…Cardiopulmonary bypass (CPB) via the axillary artery has become an alternative perfusion site especially in acute aortic dissections and patients with severe aortic atherosclerosis [1][2][3][4][5][6][7]. Despite several advantages of axillary artery cannulation such as antegrade perfusion of the aorta, problems and complications of this technique are getting known with increased use.…”

Section: Introductionmentioning

confidence: 99%

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Technical problems and complications of axillary artery cannulation

Schachner

Nagiller

Zimmer

et al. 2005

European Journal of Cardio-Thoracic Surgery

152

135

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Objective: Cardiopulmonary bypass via the axillary artery is frequently used especially in aortic dissections. With an increased use of this technique problems were recognized too. We describe the technical problems and complications associated with axillary artery cannulation. Methods: Sixty-five patients underwent cannulation of the axillary artery. The indication for operation was acute aortic dissection type A in 57%, chronic aortic dissection in 8%, aortic aneurysm in 18%, pseudoaneurysm in 3%, and others in 14%. Results: Technical problems and complications occurred in 14%, and in 11% the perfusion had to be switched to either femoral (nZ5) or aortic cannulation (nZ2). Arterial damage or dissection of the axillary artery or the aorta occurred in 0% of the sidegraft technique, whereas they were found in 9% with direct cannulation (PZn.s.). Cannulation problems or insufficient CPB flow due to a narrow vessel occurred in 0% of the sidegraft technique, whereas they were found in 4% with direct cannulation (PZn.s.). Malperfusion in aortic dissections occurred in 20% of the sidegraft technique, whereas they were found in 0% with direct cannulation (PZ0.016). No postoperative complications related to axillary cannulation which were evaluated by clinical examination, such as brachial plexus injury, axillary artery thrombosis or local wound infection were observed. Conclusions: Although axillary artery cannulation is an attractive alternative to femoral cannulation there needs to be an alertness for technical problems. Different complications occur with either direct cannulation or the sidegraft technique and at present it remains the surgeons preference which technique for axillary artery cannulation is used.

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Section: Cannulation Problems/low Cpb Flowmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Technical problems and complications of axillary artery cannulation

Schachner

Nagiller

Zimmer

et al. 2005

European Journal of Cardio-Thoracic Surgery

152

135

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“…Another reason it has been proposed is because the left subclavian artery is less prone to obstruction or dissection than the right. [10,12] Schachner et al [13] report that in 14% of their series, they had to switch the cannulation site to the ascending aorta or the femoral artery, but we did not face that kind of complication.…”

Section: Discussionmentioning

confidence: 79%

“…Watanabe et al [10] report that axillary arterial cannulation is useful, especially in the following conditions: (i) coexistence of abdominal or iliac aneurysm; (ii) coexistence of chronic peripheral arterial occlusive disease; (iii) extension of aortic dissection to the femoral artery; and (iv) considerably narrow true lumen compressed by the false lumen in aortic dissection. In the 392-patient series of Sabik et al, [11] the indications for axillary cannulation were a calcified ascending aorta in 32%, an ascending aortic aneurysm in 29%, type 1 aortic dissection in 21%, cardiac reoperation in 18%, and a calcified femoral artery in 6%.…”

Section: Discussionmentioning

confidence: 99%

Axillary artery cannulation in ascending aortic pathologies

Tuncer¹

2011

Turkish J Thorac Cardiovasc Surg

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Amaç: Bu çalışmada kardiyopulmoner bypass (KPB) için aksiller kanülasyonun sonuçları ve mortalite ve morbiditeye etki eden faktörler incelendi. Ça lış ma pla nı: Kasım 2006 -Ocak 2009 tarihleri arasında çıkan aort patolojileri nedeniyle ameliyata alınan 84 hasta (58 erkek, 26 kadın; ort. yaş 53.8±13.2 yıl; dağılım 20-77 yıl) aksiller kanülasyonla ameliyat edildi. Toplamda 84 hastaya 124 işlem uygulandı ve en sık uygulanan işlem 64 hastaya (%76.2) yapılan çıkan aort replasmanıydı. En sık ameliyat endikasyonu 51 hastada (%60.7) bulunan çıkan aort anevrizmasıydı. Üç hasta (%3.6) daha önce açık kalp ameliyatı geçirmişti. Hipotermik dolaşım arresti 51 hastada (%60.7) kullanıl-dı ve aksiller arter 75 hastada (%89.3) doğrudan, dokuz hastada (%10.7) ise bir yan greft aracılığıyla kanüle edildi. Bul gu lar: Ameliyat sonrasında hastaların üçünde (%3.6) sepsis, ameliyat sırası kanama ve düşük kardiyak debi sendromu nedeniyle hastane mortalitesi meydana geldi. Hastaların 10'unda (%11.9) nörolojik komplikasyonlar görüldü (8'inde geçici nörolojik disfonksiyon ve 2'sinde inme). Ortalama hastanede kalma süresi 5.1±5.6 (dağı-lım 1-46) gündü. Ameliyat sonrası ortalama takip süresi 10.3±5.5 (dağılım 1-15.5) aydı (toplam 68.5 hasta/yıl). Taburcu sonrası takip sürecinde mortalite görülmedi. Kanülasyon yöntemi ile mortalite ya da nörolojik komplikasyonlar arasında herhangi bir ilişki saptanmadı. So nuç:Aksiller arter arteriyel kanülasyon için güvenli bir yoldur ve aksiller yol ameliyat sonrası mortalite ve morbiditede artışa neden olmaz.Anah tar söz cük ler: Çıkan aort; aksiller arter kanülasyonu; selektif antegrad serebropleji. Background:We analyzed the results of axillary cannulation for cardiopulmonary bypass (CPB) and the factors affecting mortality and morbidity. Methods: Eighty-four patients (58 males, 26 females; mean age 53.8±13.2 years; range 20 to 77 years) were operated on for ascending aortic pathologies with axillary arterial cannulation between November 2006 and January 2009. Overall, 124 procedures were performed in 84 patients, and the most commonly performed procedure was the replacement of the ascending aorta which was employed in 64 patients (76.2%). The most common indication for operation was ascending aortic aneurysm that was present in 51 patients (60.7%). Three (3.6%) patients had previously undergone open heart surgery. Hypothermic circulatory arrest was used in 51 (60.7%) patients, and the axillary artery was cannulated directly in 75 (89.3%) patients and via a side graft in nine (10.7%) patients. Results: Postoperatively, three patients (3.6%) had in-hospital mortality because of sepsis, intraoperative bleeding, and low cardiac output syndrome. Neurological complications were seen in 10 (11.9%) patients (8 had transient neurological dysfunction and 2 had stroke). The mean duration of hospital stay was 5.1±5.6 (range 1 to 46) days. Postoperative follow-up was 10.3±5.5 (range 1 to 15.5) months on average (total of 68.5 patient/years). There was no mortality during the follow-up after discharge. No relationsh...

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“…With this rapid and safe cannulation method extracorporeal circulation can be easily established, thus reducing the risk of perioperative shock and increased mortality [13]. Cardiopulmonary bypass via axillary/subclavian artery has become an alternative perfusion site in the past decade, predominantly in acute aortic dissections but also for patients with severe aortic atherosclerosis [14][15][16][17][18][19][20]. Despite several advantages of axillary/subclavian artery cannulation such as dominantly antegrade perfusion of the aorta, this technique is not without its complications.…”

Section: Perfusion Approaches In Type a Dissectionsmentioning

confidence: 99%