Dp. Bichell et al., AXILLOAXILLARY CARDIOPULMONARY BYPASS - A PRACTICAL ALTERNATIVE TO FEMOROFEMORAL BYPASS, The Annals of thoracic surgery, 64(3), 1997, pp. 702-705
Background. Peripheral arterial and venous cannulation for cardiopulmo
nary bypass is used increasingly for patients undergoing minimally inv
asive cardiac operations, complex reoperations, or repair of aortic di
ssection or aneurysm, and for patients with extensive arteriosclerotic
aortic disease in whom aortic cannulation is a prohibitive embolic ri
sk. The common femoral artery and vein are most commonly used for peri
pheral cannulation, but these sites may be predisposed to complication
s, primarily because the femoral vessels are commonly involved with ar
teriosclerotic disease. We have recently begun to use the axillary art
ery and axillary vein as alternative cannulation sites, achieving full
cardiopulmonary bypass, providing antegrade aortic flow, and avoiding
many of the complications associated with other sites. Methods. Seven
patients with peripheral vascular or aortic disease, or both, prohibi
ting safe aortic or femoral cannulation underwent cardiopulmonary bypa
ss through axillary artery and axillary vein cannulation, approached t
hrough a small single subclavicular incision. Results. All patients we
re successfully cannulated and axilloaxillary cardiopulmonary bypass w
as possible without the need for additional cannulas. All auxiliary ve
ssels were closed primarily without complication. Conclusion. For an e
xpanding population of patients with peripheral vascular and aortic di
sease, axilloaxillary bypass is a safe and practical alternative to ao
rtic or femoral cannulation. (C) 1997 by The Society of Thoracic Surge
ons.