AXILLARY ARTERY - AN ALTERNATIVE SITE OF ARTERIAL CANNULATION FOR PATIENTS WITH EXTENSIVE AORTIC AND PERIPHERAL VASCULAR-DISEASE

The increasing number of patients with extensive aortic and peripheral vascular atherosclerosis or aneurysms who are undergoing cardiac oper ations present difficult decisions as to the optimal site of arterial cannulation for cardiopulmonary bypass. Femoral artery cannulation is the most common alternative to ascending aortic cannulation, but sever e iliofemoral disease or the danger of atheroemboli caused by retrogra de perfusion through an atherosclerotic or aneurysmal descending aorta may make this approach impossible or undesirable. We have used axilla ry artery cannulation for cardiac operations in 35 patients for indica tions including severe aortic atherosclerosis (n = 16), extensive aort ic aneurysms (n = 11), and aortic dissection (n = 8). The cardiac oper ations performed were coronary artery bypass grafting (n = 9) aortic v alve replacement (n = 1), aortic valve replacement and coronary artery bypass grafting (n = 5), repair of mitral valve periprosthetic leak ( n = 1), and resection of ascending and/or aortic arch (n = 19). Deep h ypothermia with circulatory arrest was used in 26 patients and retrogr ade cerebral perfusion in 18. All patients awoke from the operation an d no patient had a cerebrovascular accident. One patient required axil lary artery thrombectomy and one patient had a mild ipsilateral brachi al plexus paresis after the operation, Four patients died in the hospi tal. We conclude that axillary artery cannulation is a safe and effect ive means of providing antegrade arterial flow during cardiopulmonary bypass in patients with severe atherosclerotic or aneurysmal disease. This strategy may lower the prevalence of stroke associated with cardi opulmonary bypass in these patients.