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Axillary Artery Cannulation

Wednesday, February 20, 2019

Sabe AA, Hughes GC. Axillary Artery Cannulation. February 2019. doi:10.25373/ctsnet.7746386.

The authors review axillary artery cannulation indications and technique. They focus on the relevant anatomy, surgical preparation, and cannulation technique. They also show their approach for reoperative axillary artery cannulation and discuss potential complications and pitfalls.


This video is part of the Cardiac Surgery Essentials Series, brought together by CTSNet Guest Editor Dr Tsuyoshi Kaneko. Find the whole series here.

Comments

What is your rationale for exposing the artery in its third anatomical portion? (I have found it easy to work medial to the pectoralis minor through a similar incision and easy to avoid the brachial plexus and arterial branches) What pressure parameters do you use on bypass? Do you restrict flow partially to the arm by looping and partially snaring the artery distal to the graft? If so, for the entire pump run or during antegrade cerebral perfusion only?? Any tips for Impella 5.0 implant??
To answer your question, its easier in this location. We have used this approach for ax-bifemoral bypassses in pts with infected AAA grafts . We used to perform carotid subclavian bypasses in pts with TAA to extend the landinding zone for a TEVAR. In pts with large body habitus this can be difficult. For complex type A dissections with a need for sustained antegrade cerebral perfusion , this provides an optimal appproach in my humble opinion. But I am a dinosauer who grew up in the "operative " era ?
I wish you had shown the actual "exposure" of the artery!! Sometimes it's easily found but sometimes I struggle just to locate the artery even when making the same incision that you recommend. I would also recommend putting on the 3/8" connectory BEFORE doing the anastomosis so as not to pull on the anastomosis. We also have gone to using a "Gelweave' graft which will "ooze" much less.

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