Femoral artery cannulation for thoracic aortic surgery: safe under transesophageal echocardiographic control

Choice of cannulation site (femoral, axillary) for cardiopulmonary bypass for thoracic aortic surgery is controversial. We review a single-center consecutive experience with femoral cannulation in the era of transesophageal echocardiography (TEE).

Femoral artery cannulation is our preference for both aneurysms and dissections. If intraoperative TEE (or preoperative computed tomography) shows mobile atheroma, we avoid femoral cannulation and use the right axillary artery. Charts were reviewed to detect any cannulation- or perfusion-related complications.

Eight hundred eighty patients underwent cannulation for cardiopulmonary bypass for thoracic aortic surgery: 767 femoral (87%) and 113 other (13%, 87 aortic, 22 axillary, 4 innominate). Among the femoral cases, 673 (87.7%) were elective and 94 (12.2%) urgent or emergency. Hospital survival was 723 of 767 (94%): 654 of 673 (97%) for elective cases and 69 of 94 (73%) for urgent or emergency cases. Survivals were 549 of 572 (95%) for ascending and arch, 91 of 97 (93%) for descending, and 83 of 98 (84%) for thoracoabdominal. Stroke (fixed neurologic deficit) occurred in 14 of 767 cases (1.8%): 9 ascending or arch and 5 descending or thoracoabdominal. There were 5 paraplegias in the descending or thoracoabdominal group. There was 1 instance of intraoperative descending dissection (well tolerated), no arterial ruptures, and 6 instances (0.7%) of local femoral arterial narrowing requiring surgical correction (patch graft). One patient (0.1%) had postoperative ischemia of the cannulated limb, and 25 patients (3.2%) had local wound problems (infection 21, seroma 4) treated conservatively.

This large experience in the TEE era strongly supports femoral cannulation for aortic surgery, with good survival, low stroke rate, minimal perfusion-related rupture or dissection, and minimal limb ischemia. If intraoperative TEE shows mobile atheroma, axillary cannulation is preferred.