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Cannulation of the axillary artery with a side graft reduces morbidity
Joseph F Sabik1, Hassan Nemeh, Bruce W Lytle
1Department of Thoracic and Cardiovascular Surgery and Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. sabikj@ccf.org
Insights
Using a side graft for axillary artery cannulation during cardiopulmonary bypass significantly reduces cannulation-related morbidity compared to direct cannulation. This method is recommended for improved patient safety.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Cardiopulmonary Bypass
Background:
- Axillary artery cannulation is a preferred alternative when the ascending aorta is inaccessible.
- Historically, direct cannulation was employed; current practice involves using a side graft.
- This study evaluates morbidity associated with axillary artery cannulation and the impact of using a side graft.
Purpose of the Study:
- To investigate the morbidity associated with axillary artery cannulation.
- To determine if employing a side graft reduces cannulation-related complications.
Main Methods:
- A retrospective analysis of 399 axillary artery cannulations in 392 patients from January 1993 to January 2001.
- Patients underwent either direct axillary artery cannulation (n=212) or side graft cannulation (n=187).
- Cannulation-related morbidity was compared between groups, with propensity score adjustment and matching.
Main Results:
- Overall cannulation-related morbidity was low, including brachial plexus injury (1.8%), axillary artery damage (1.8%), aortic dissection (0.8%), and arm ischemia (0.8%).
- The side graft group experienced significantly lower morbidity (2.1%) compared to the direct cannulation group (7.0%, p=0.03).
- Propensity score adjustment confirmed that side graft use reduced the odds of morbidity by 85% (OR=0.15, p=0.002).
Conclusions:
- Axillary artery cannulation for cardiopulmonary bypass is associated with low morbidity.
- Cannulation using a side graft demonstrates significantly less morbidity than direct cannulation.
- Routine use of a side graft is recommended for axillary artery cannulation to minimize complications.
Background:
The axillary artery is our preferred arterial cannulation site when the ascending aorta cannot be cannulated. Previously, we cannulated the artery directly; now we use a side graft. The purposes of this study were to (1) investigate cannulation-related morbidity and (2) determine whether use of a side graft reduces it.
Methods:
From January 1993 to January 2001, 392 patients underwent 399 axillary artery cannulations. Indications included calcified ascending aorta (129, 32%), ascending aortic aneurysm (115, 29%), type I aortic dissection (85, 21%), cardiac reoperation (70, 18%), and calcified femoral artery (26, 6%). The axillary artery was cannulated directly in 212 (53%) and with a side graft in 187 (47%). Comparisons of cannulation-related morbidity between the direct cannulation and side graft groups were made overall and after both adjusting and matching for propensity score.
Results:
Cannulation-related morbidity was infrequent, with brachial plexus injury in 7 (1.8%), axillary artery damage in 7 (1.8%), aortic dissection in 3 (0.8%), and arm ischemia in 3 (0.8%). Only 4 of 187 (2.1%) occurred in the side graft group, versus 16 of 212 (7.0%) with direct cannulation (p = 0.03). After propensity adjustment, the odds ratio for reduction of risk of cannulation-related morbidity with use of a side graft was 0.15 (p = 0.002).
Conclusions:
Use of the axillary artery as inflow for cardiopulmonary bypass is associated with low morbidity. However, cannulation with a side graft was associated with less cannulation-related morbidity than direct cannulation. Routine use of a side graft is recommended whenever axillary artery cannulation is indicated.
