How to perform a direct axillary artery cannulation

The choice of the arterial cannulation site has been a matter of debate over the years. The femoral artery has been used for a long time due to its ease of isolation and the possibility of percutaneous cannulation. However, it is associated with the risk of embolization because of the retrograde flow, and it is more dangerous in the case of aortic dissection because perfusion is unpredictable and retrograde flow exposes the patient to the risk of malperfusion. Cannulation of the axillary artery has recently gained popularity because of its advantages, in particular for antegrade aortic perfusion during cardiopulmonary bypass and for its ability to facilitate cerebral perfusion during hypothermic circulatory arrest. We show tips and tricks to facilitate the isolation and direct cannulation of the axillary artery because we think that this procedure should be practiced by all cardiac surgeons, even those who are just beginning their practices.