AXILLOAXILLARY CARDIOPULMONARY BYPASS - A PRACTICAL ALTERNATIVE TO FEMOROFEMORAL BYPASS

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.