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J Thorac Cardiovasc Surg 1999;118:1153
© 1999 Mosby, Inc.

LETTERS TO THE EDITOR

Axillary artery cannulation

Department of Thoracic and Cardiovasclar Surgery/F25, The Cleveland Clinic Foundation, 9500 Euclid Ave
Cleveland, OH 44195

To the Editor:

We read with interest the recent article by Neri and associates ¹ concerning the use of axillary artery cannulation in patients with type A aortic dissection. They used axillary artery cannulation in 22 of 152 (14%) operations for aortic dissection over a 9-year period. The primary indication for axillary artery cannulation was inability to establish safe perfusion via the femoral artery. The technique was successful in all patients, and the authors conclude that the axillary artery is a safe alternate site for arterial perfusion in patients with type A dissection.

We agree that the axillary artery provides excellent arterial access for cardiopulmonary bypass, and we would like to offer a few comments concerning our indications for axillary artery cannulation and the surgical technique. Since 1991, we have used axillary artery perfusion in more than 100 patients. Our indications for axillary artery cannulation are broad and include ascending aortic aneurysm, ascending aortic dissection, and severe ascending aortic atherosclerosis. In fact, the axillary artery is our site of choice for arterial perfusion in patients with type A dissection; the dissection rarely extends into the axillary artery. ² Similarly, in patients with ascending aortic atherosclerosis, the axillary artery is usually spared from the disease process; furthermore, axillary artery perfusion in such patients reduces the risk of atheroembolism, which may occur with retrograde perfusion via the femoral artery. Contraindications to axillary artery cannulation include extension of the aortic disease process into the artery and known axillary/subclavian stenosis. In addition, morbid obesity is a relative contraindication, as exposure of the artery in such patients can be difficult. Operations performed with the use of axillary artery cannulation include ascending aortic replacement, valve repair and replacement, and coronary artery bypass grafting.

Our surgical technique has evolved and differs somewhat from that of the authors. As previously reported, ³ we most frequently use the right axillary artery. We have not encountered problems with malperfusion via this vessel. Although we initially cannulated the artery directly, we now prefer to sew an 8-mm Dacron graft to the vessel and then cannulate the graft with a 20F cannula. The axillary artery is frequently fragile, and this technique avoids the trauma of direct cannulation. In addition, this technique allows perfusion of the arm during cardiopulmonary bypass and facilitates decannulation, which is accomplished simply by transecting the graft and oversewing the short stump. ⁴ Adequacy of perfusion is confirmed by transesophageal echocardiography and measurement of blood pressure in both radial arteries.

In our practice, the axillary artery has replaced the femoral artery as the preferred alternate site for cannulation in patients with ascending aortic disease. Arterial inflow via a Dacron graft provides advantages over direct cannulation of the axillary artery.

References

1. Neri E, Massimo M, Capannini G, Carone E, Tucci E, Diciolla F, et al. Axillary artery cannultion in type A aortic dissection operations. J Thorac Cardiovasc Surg 1999;118:324-9. [Abstract/Free Full Text]
   
2. Borst HG. In: Borst HG, Heinemann MK, Stone CD, editors. Surgical treatment of aortic dissection, 1st ed. New York: Churchill Livingstone; 1996. p. 255-68.
   
3. Sabik JF, Lytle BW, McCarthy PM, Cosgrove DM. Axillary artery: an alternative site of arterial cannulation for patients with extensive aortic and peripheral vascular disease. J Thorac Cardiovasc Surg 1995;109:885-91. [Abstract]
   
4. Baribeau YR, Westbrook BM, Charlesworth DC, Maloney CT. Arterial inflow via an axillary artery graft for the severely atheromatous aorta. Ann Thorac Surg 1998;66:33-7. [Abstract/Free Full Text]
   

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This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): A. Marc Gillinov Joseph F. Sabik Bruce W. Lytle Delos M. Cosgrove Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gillinov, A. M. Articles by Cosgrove, D. M. Search for Related Content PubMed PubMed Citation Articles by Gillinov, A. M. Articles by Cosgrove, D. M.