[HSF] Aortic dissection and CPR

[psimha]

1: Eur J Cardiothorac Surg. 2005 Apr;27(4):634-7.

Technical problems and complications of axillary artery cannulation.

Schachner T, Nagiller J, Zimmer A, Laufer G, Bonatti J.

Department of Cardiac Surgery, Innsbruck University Hospital, Anichstrasse 35,
A-6020 Innsbruck, Austria. thomas.schachner at uibk.ac.at

OBJECTIVE: Cardiopulmonary bypass via the axillary artery is frequently used
especially in aortic dissections. With an increased use of this technique
problems were recognized too. We describe the technical problems and
complications associated with axillary artery cannulation. METHODS: Sixty-five
patients underwent cannulation of the axillary artery. The indication for
operation was acute aortic dissection type A in 57%, chronic aortic dissection in
8%, aortic aneurysm in 18%, pseudoaneurysm in 3%, and others in 14%. RESULTS:
Technical problems and complications occurred in 14%, and in 11% the perfusion
had to be switched to either femoral (n=5) or aortic cannulation (n=2). Arterial 
damage or dissection of the axillary artery or the aorta occurred in 0% of the
sidegraft technique, whereas they were found in 9% with direct cannulation
(P=n.s.). Cannulation problems or insufficient CPB flow due to a narrow vessel
occurred in 0% of the sidegraft technique, whereas they were found in 4% with
direct cannulation (P=n.s.). Malperfusion in aortic dissections occurred in 20%
of the sidegraft technique, whereas they were found in 0% with direct cannulation
(P=0.016). No postoperative complications related to axillary cannulation which
were evaluated by clinical examination, such as brachial plexus injury, axillary 
artery thrombosis or local wound infection were observed. CONCLUSIONS: Although
axillary artery cannulation is an attractive alternative to femoral cannulation
there needs to be an alertness for technical problems. Different complications
occur with either direct cannulation or the sidegraft technique and at present it
remains the surgeons preference which technique for axillary artery cannulation
is used.

PMID: 15784364 [PubMed - indexed for MEDLINE]

Related Links

    Is the axillary artery a suitable cannulation site in aortic surgery? [J
Cardiovasc Surg (Torino). 2004] PMID:15041930

    Cannulation of the axillary artery with a side graft reduces morbidity. [Ann
Thorac Surg. 2004] PMID:15063259

    Axillary artery cannulation: routine use in ascending aorta and aortic arch
replacement. [Ann Thorac Surg. 2004] PMID:15223412

    Axillary artery cannulation in type a aortic dissection operations. [J Thorac
Cardiovasc Surg. 1999] PMID:10425006

    Right axillary artery cannulation for surgical management of the hostile
ascending aorta. [Tex Heart Inst J. 2005] PMID:16107111


Ben Bidstrup wrote:
> I have seen and heard of similar events when femoral cannulation is 
> used. Take the clamp off the distal anastomosis and the false lumen 
> blows up. No head circulation and off to the basement.
>
> I have used direct cannulation when axillary has not been successful.
>
> Has any one any tricks re axillary cannulation esp determining whether 
> it is involved. I had one that I am sure dissected (more ?) when the 
> pump was turned on and the perfusion pressure went to 300 mm Hg.
>
>
>