Axillary artery cannulation in type A aortic dissection operations

Background: Femoral arteries are the preferred site of peripheral cannulati on for arterial inflow in type A aortic dissection operations. The presence of aortoiliac aneurysms, severe peripheral occlusive disease, atherosclero sis of the femoral vessels, and distal extension of the aortic dissection m ay preclude their utilization. Axillary artery cannulation may represent a valid alternative in these circumstances. Methods: Between January 15, 1989 , and August 20, 1998, in our institution, 22 of 152 operations (14.4%) for acute type A aortic dissection were performed with the use of the axillary artery for the arterial inflow. Axillary artery cannulation was undertaken in the presence of femoral arteries bilaterally compromised by dissection in 12 patients (54.5%), abdominal aorta and peripheral aneurysm in 5 patien ts (22.7%), severe atherosclerosis of both femoral arteries in 3 patients ( 13.6%), and aortoiliac occlusive disease in 2 patients (9.1%). In all patie nts, distal anastomosis was performed with an open technique after deep hyp othermic circulatory arrest, Retrograde cerebral perfusion was used in 9 pa tients (40.9%), Results: Axillary artery cannulation was successful in all patients. The left axillary artery was cannulated in 20 patients (90.9%), a nd the right axillary artery was cannulated in 2 patients (9.1%), Axillary artery cannulation followed an attempt of femoral artery cannulation in 15 patients (68.2%), All patients survived the operation, and no patient had a cerebrovascular accident. No axillary artery thrombosis, no brachial plexu s injury, and no intraoperative malperfusion were recorded in this series, Two patients (9.1%) died in the hospital of complications not related to ax illary artery cannulation, Conclusions: In patients with type A aortic diss ection in whom femoral arteries are acutely or chronically diseased, axilla ry artery cannulation represents a safe and effective means of providing ar terial inflow during cardiopulmonary bypass.