Technical problems and complications of axillary artery cannulation

Schachner, Thomas; Nagiller, J.; Zimmer, Anne; Laufer, Guenther; Bonatti, Johannes

doi:10.1016/j.ejcts.2004.12.042

Cited by 152 publications

(152 citation statements)

References 8 publications

(17 reference statements)

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“…Schachner et al experienced complications in 14% and needed to change the routes in 11% of cases. 93) Although direct cannulation is simple and quick, it may necessitate addition or switch of routes due to an insufficient flow rate or it can be associated with damage to the axillary artery or even dissection to the aorta. 93,94) Wong et al reported weakness or numbness of the arm without arm ischemia, 95) potentially due to injury on the brachial plexus.…”

Section: Perfusion Routementioning

confidence: 99%

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Orihashi¹

2012

Annals of Vascular Diseases

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Despite improved outcomes of acute type A aortic dissection (AAAD), many patients die at the moment of onset, and hospital mortality is still high. This article reviews the latest literature to seek the best possible way to optimize outcomes. Delayed diagnosis is caused by variation in or absence of typical symptoms, especially in patients with neurological symptoms. Misdiagnosis as acute myocardial infarction is another problem. Improved awareness by physicians is needed. On arrival, quick admission to the OR is desirable, followed by assessment with transesophageal echocardiography, and malperfusion already exists or newly develops in the OR; thus, timely diagnosis without delay with multimodality assessment is important. Although endovascular therapy is promising, careful introduction is mandatory so as not to cause complications. While various routes are used for the systemic perfusion, not a single route is perfect, and careful monitoring is essential. Surgical treatment on octogenarians is increasingly performed and produces better outcomes than conservative therapy. Complications are not rare, and consent from the family is essential. Prevention of AAAD is another important issue because more patients die at its onset than in the following treatment. In addition to hereditary diseases, including bicuspid aortic valve disease, the management of blood pressure is important.Keywords: aortic dissection, malperfusion, complication, echocardiography A cute type A aortic dissection (AAAD) not only causes sudden death at the time of onset but leads to various life-threatening complications. In spite of improved diagnostic imaging and surgical strategies, in-hospital mortality is still high, and patients who have survived often suffer from sequelae that make subsequent quality of life poor. This article is aimed to review the latest literature and ideas to seek the best possible way to minimize undesirable results.Various complications of AAAD caused by separation of the aortic wall to outer and inner layers are summarized as three categories: 1) aortic rupture due to disruption of the outer layer; 2) malperfusion caused by the inner layer, that is, the intimal flap; and 3) aortic regurgitation by a deformed aortic valve, leading to acute heart failure. Approximately 20% of patients instantaneously die due to aortic rupture, 1) and 1 to 2% of the remaining patients die every hour unless appropriately treated. 2) Although surgical outcomes are gradually improving, in-hospital mortality of surgical patients (repair on the aortic root to the arch) in 2009 was as high as around 10%, according to the Japanese database. 3) For the further improvement of outcomes, problems should be solved in each of preonset, pre-hospital, and in-hospital stages. In this review, the latter two stages are discussed first, since most of the literature focuses on these stages. After that, the issue of pre-onset stage, i.e., prevention is discussed. DelayeD DiagnosisIn consideration of the natural history of AAAD, the "chain of onset-to-sur...

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Section: Perfusion Routementioning

confidence: 99%

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Orihashi¹

2012

Annals of Vascular Diseases

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“…Schachner et al [23] reported their experience attained in 65 surgeries using CPB with axillary arterial access. Twenty patients were submitted to arterial cannulation using polytetrafluoroethylene grafts (PTFE), while direct cannulation was performed in the other patients.…”

Section: Right Axillary/right Subclavian Arterymentioning

confidence: 99%

“…The best access route, the use of grafts or direct cannulation of the artery and the complications of these different methods are still discussed today [13,14,18,[22][23][24][25].…”

Section: Right Axillary/right Subclavian Arterymentioning

confidence: 99%

Proteção cerebral: sítios de canulação arterial e vias de perfusão do cérebro

Dias¹,

Silva²,

Fiorelli³

et al. 2007

Rev Bras Cir Cardiovasc

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Brain perfusion for adequate cerebral protection has changed over the years. The limitations of the time during total circulatory arrest with deep hypothermia, the inefficient cerebral metabolism during retrograde perfusion and special care to prevent cerebral embolism during antegrade perfusion have resulted in the development of different methods of cerebral protection during the evolution of aortic arch operations. Antegrade cerebral perfusion associated with moderate hypothermia is today, considered the best option for cerebral protection. 236DIAS, RR ET AL -Cerebral protection: sites of arterial cannulation and brain perfusion routes Braz J Cardiovasc Surg 2007; 22(2): 235-240

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“…In addition, during axillary artery cannulation, problems such as cerebral ischemia and ischemia of the upper extremities can occur; thus, it may not be useful in all cases. [12][13][14] Furthermore, the use of cannulation of the ascending aorta to treat acute aortic dissection has also been reported. 4,5,15,16) Some institutions (such as ours) use the Seldinger technique for artery puncture and cannulation, 15,17) while others use direct cannulation for ordinary open heart surgery.…”

Section: Intraoperative Parameter(s) (Table 2)mentioning

confidence: 99%

Direct and Transapical Central Cannulation for Acute Type A Aortic Dissection

Wada

Matsumura

Minematsu

et al. 2014

Annals of Vascular Diseases

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Objective: The choice of cannulation site for the treatment of acute Stanford type A aortic dissection is much debated. We believe that central cannulation is quick to perform, easy to use, and safe to manage acute type A aortic dissection. Materials and Methods: We retrospectively investigated 26 cases of acute aortic dissection performed using two different central cannulation methods between April 2011 and March 2012. Direct ascending aortic cannulation was performed using the Seldinger technique in 20 patients, and transapical ascending aortic cannulation was performed in six patients in whom puncture was difficult. Results: Patients were 21-86 years old (mean age, 67 years). The surgical techniques used to treat aortic dissection were hemiarch repair in 21 patients and total arch replacement in 5 patients. The mean length of surgery was 393 min. One death (3.8%) was attributed to intestinal ischemia. Conclusion: During surgery for acute aortic dissection, central cannulation using either transapical or direct puncture can be performed quickly and safely, and satisfactory short-term outcomes can be obtained. Because acute aortic dissection can present with various conditions, there is no single perfect surgical or cannulation method; therefore, the choice of surgical procedure should be individualized for each patient.

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Technical problems and complications of axillary artery cannulation

Cited by 152 publications

References 8 publications

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Proteção cerebral: sítios de canulação arterial e vias de perfusão do cérebro

Direct and Transapical Central Cannulation for Acute Type A Aortic Dissection

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