Axillary artery cannulation

Area of Science:

• Cardiovascular Surgery
• Thoracic Aortic Surgery
• Vascular Access

Background:

• Standard ascending aorta cannulation may be precluded by aortic root and arch pathologies.
• Axillary artery cannulation offers an alternative access route for cardiopulmonary bypass.
• Previous studies suggest potential benefits in cerebral protection and reduced embolization.

Purpose of the Study:

• To evaluate the indications and benefits of axillary artery cannulation in thoracic aortic surgery.
• To compare axillary cannulation with standard ascending aorta and femoral cannulation regarding cerebral protection and embolization.
• To highlight the utility of axillary cannulation in complex aortic pathologies.

Main Methods:

• Review of clinical indications for axillary artery cannulation.
• Comparison of axillary cannulation with ascending aorta and femoral cannulation in relevant surgical scenarios.
• Analysis of experimental data on cerebral embolization rates.

Main Results:

• Axillary cannulation provides antegrade systemic flow, facilitating antegrade cerebral perfusion.
• It reduces the rate of retrograde cerebral embolization compared to femoral cannulation.
• Experimental data supports reduced cerebral emboli compared to standard ascending aorta cannulation.

Conclusions:

• Axillary artery cannulation is a valuable alternative for surgeries involving the aortic root and arch, especially when standard cannulation is not possible.
• It offers advantages in cerebral perfusion and reduced embolic risk.
• Indications include ascending aortic aneurysms extending to the arch, isolated arch aneurysms, type A aortic dissection, and re-operations.