Apart from an increased use in patients requiring left ventricular circulatory support, i. The senior authors technique will be highlighted and illustrated through an accompanying video, with discussion of helpful methods to avoid common pitfalls. Femoral cannulation is safe for type a dissection repair. Axillary artery cannulation is a viable alternative method for preserving cardiac blood flow and limiting the risks of femoral artery cannulation. Axillary artery cannulation with a dacron graft for surgery of the. Cannulation techniques for cardiopulmonary bypass thoracic key. The femoral artery and vein have been the preferred cannulation sites for cardiopulmonary bypass in such cases, although alternative sites such as the axillary arteries, and supraaortic branches have been proposed. With both forms of ecmo, the ventilator settings are decreased to allow recovery of lungs, but generally peep is maintained at higher pressure e. Femoral artery cannulation, axillary artery cannulation, and central. Cannulation of peripheral vessels is being frequently used as a standard access for establishing cardiopulmonary bypass cpb in recent times. Unlike most surgeons, i prefer to cannulate the axillary artery directly with a special angled low profile cannula rather than utilizing a chimney graft. Cannulation of the axillary artery for cardiopulmonary bypass. However the presence of peripheral dis ease such as aortoiliac aneurysms, distal extension of the aortic.
Cureus axillary approach for venoarterial extracorporeal. No postoperative complications related to axillary cannulation which were evaluated by clinical examin. The postoperative length of icu stay was 3 172 days in the whole series. Left axillary artery perfusion in surgery of type a aortic. Performing axillary artery cannulation, during cardiopulmonary bypass in patients with an atherosclerotic ascending aorta or acute dissection of the ascending aorta and arch. Despite several advantages of axillary artery cannulation such as antegrade perfusion of the aorta, problems and complications of this technique are getting known.
Pdf axillary artery cannulation for arterial inflow in. Choosing an ideal cannulation site, employing peri and intraoperative imaging, selecting an appropriate cannula, and avoiding complications are vital to success. Axillary artery cannulation for cardiopulmonary bypass. Reoperative aortic valve replacement after previous coronary. The femoral artery has been the standard cannulation site for cardiopulmonary bypass in treating acute aortic dissection type a aada. Cannulation for ecmo is done by a pediatric surgeon and patient management is by neonatology. The ascending aorta is the customary site for arterial cannulation for cardiopulmonary bypass. Axillary artery cannulation was increasingly used for cardiopulmonary bypass, especially in acute aortic dissection type a.
Combined femoral and axillary perfusion strategy for. Axillary artery cannulation for cardiopulmonary bypass reduces cerebral microemboli nasim hedayati, md j. A simple method to establish antegrade cerebral perfusion. Extracorporeal membrane oxygenation with right axillary artery. Basics of cardiopulmonary bypass rsna publications online. Cardiopulmonary bypass cpb is a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the patients body. Clinical experience with axillary artery cannulation led to the hypothesis that axillary cannulation may be cerebroprotective. Some adverse, clinically important outcomes may be related to events at this time. Aortic calcification or disease requiring replacement precludes aortic cannulation. Aug 27, 2015 a 72yearold man underwent aortic valve replacement and coronary artery bypass graft using cardiopulmonary bypass with right axillary artery cannulation. With an increased use of this technique problems were recognized too. However, axillary artery cannulation also involves problems because it requires a more precise technique and more time. Axillary artery cannula was considered to compress right subclavian and disturb venous return in the right subclavian vein.
Transapical aortic cannulation for cardiopulmonary bypass. Figure 5 from cannulation of the right axillary artery for. Oct 16, 2018 cardiac surgery has made significant progress since the advent of cardiopulmonary bypass. Normal postoperative findings related to cardiopulmonary bypass include a felt pledgets, which are used to reinforce cannulation. This study reports our experience with reusing the axillary artery for cardiopulmonary bypass during complex aortic and cardiac surgical procedures. Cardiopulmonary bypass via common carotid artery cannulation. Pdf cannulation for cardiopulmonary bypass researchgate. We used the right axillary artery for cannulation in all our patients. Femoral artery cannulation, axillary artery cannulation, and central aortic cannulation are the three major cannulation strategies that are adopted in many centers in the world. Comparison of ascending aorta versus femoral artery. Arterial cannulation for bypass is a cornerstone to most cardiac procedures. Right axillary artery cannulation via a side graft provides sufficient antegrade aortic flow of 2.
Combined femoral and axillary perfusion strategy for stanford. Femoral artery combined with axillary artery cannulation was technically successful in 327 patients. Technical problems and complications of axillary artery. Additional approaches for cannulation, aortic occlusion, and myocardial protection. Background aortic cannulation for cardiopulmonary bypass cpb is linked to cerebral microemboli emanating from the ascending aorta. Between january 1999 and may 2004, 26 patients underwent right axillary artery cannulation for cpb. Transapical aortic cannulation for cardiopulmonary bypass in. Pdf axillary artery cannulation for cardiopulmonary. Performing axillary artery cannulation, during cardiopulmonary bypass in patients with an atherosclerotic ascending aorta or acute dissection of the ascending aorta and arch, is of growing interest. Femoral cannulation has been the standard option for cannulation. Some authors used the left axillary artery as a primary site for cannulation. The mean aortic crossclamp and cardiopulmonary bypass times were 160. The indications for cannulation of the axillary artery were aortic aneurysm in 37 patients, severe aortic atherosclerosis in 28 patients, and re do surgery in 11 patients. During the cooling phase, the ascending aorta and proximal arch.
Cardiopulmonary bypass cpb via the axillary artery has become an alternative perfusion site especially in acute aortic dissections and patients with severe aortic atherosclerosis. Combined femoral and axillary perfusion strategy for stanford type a. For axillary artery cannulation and attachment of a side graft, the artery lateral to. The patient underwent aortic valve replacement for severe aortic regurgitation 8. Cannulation of the right axillary artery for surgery of acute. Petechial and subcutaneous hemorrhage with blister formations. Technical problems and complications of axillary artery cannulation.
Using the femoral artery as aortic return, however, possible complications, for example, cerebral embolization and organ malperfusion, could be caused by a retrograde blood flow. Keywords cannulation techniques, cardiopulmonary bypass step 1 surgical anatomy 1 ascending aorta cannulation sites on the ascending aorta should be as high as safely possible. Cannulation of the right axillary artery for surgery of. Surgeons today more frequently perform complete arterial revascularization, which in some cases may require delicate proximal anastomoses of arterial conduits e.
Technique the choice of an adequate, nondiseased cannulation site a transverse skin incision, 810 cm in length running for arterial inflow during cardiopulmonary bypass cpb is from a point just lateral to the sternal head of the clavicle an important point, in particular for dissections involving to the upper deltopectoral grove, is made. Our center used femoral and axillary artery cannulation for. We describe the technical problems and complications associated with axillary artery cannulation. Dermatologic complication following axillary cannulation. The purpose of venous cannulation is to drain systemic deoxygenated blood into a cardiopulmonary bypass machine. N2 background aortic cannulation for cardiopulmonary bypass cpb is linked to cerebral microemboli emanating from the ascending aorta. We report a case where we established safe cardiopulmonary bypass with common carotid artery cannulation in an adult patient. Axillary artery cannulation requires additional time as well as presenting the risk of brachial plexusdamage, seromas, and limb ischemias 4. Our aim is to present our experience, to describe the surgical technique, and to demonstrate the sufficient cerebral and total body perfusion through axillary artery. Axillary artery cannulation has been used as an alternative site for cardiopulmonary bypass during surgery for aortic dissections and aneurysmal disease of the ascending aorta and arch. Axillary artery cannulation for cardiopulmonary bypass reduces. Both the distal ascending aorta and the axillary artery have the advantage of. To limit vascular limb complications, alternative cannulation sites have been considered.
These, along with the steps to arterial cannulation, are discussed. From january 2005 through december 2008, axillary artery cannulation was used in 48 patients. Nov 10, 2020 background the optimal cannulation strategy in surgery for stanford type a aortic dissection is critical to patient survival but remains controversial. The cannulation strategy in surgery for acute type a dissection. Cannulation of the axillary artery is one possible means of establishing cardiopulmonary bypass during surgery of the ascending aorta and aortic arch. Deltoidopectoralis approach to axillary vessels for full. Does the arterial cannulation site for circulatory arrest influence. Cardiopulmonary bypass via the axillary artery is frequently used especially in aortic dissections. After undraping, petechial and subcutaneous hemorrhage with blister formations were found in right upper extremity. Cardiac surgery has made significant progress since the advent of cardiopulmonary bypass. This was following four years of experiments with dogs. Extended utilization of axillary cannulation as arterial access for acute intraoperative aortic dissection due to the arterial cannulation into the axil cardiopulmonary bypass lary artery is a rare and devastating complication 5.
Usefulness of the axillary artery as vascular access for. If the axillary artery is small, cardiopulmonary bypass. The technique allows the surgical team to oxygenate and circulate the patients blood, thus allowing the surgeon to operate on the heart. Aortic cannulation for cardiopulmonary bypass cpb is linked to cerebral microemboli emanating from the ascending aorta. Different cannulation strategies have their own advantages and drawbacks during cardiopulmonary bypass. Fa vorable experience at our institution and elsewhere using. In 2004, 8 consecutive patients received cannulation of the right axillary artery using a dacron graft. Dermatologic complication following axillary cannulation for. From 2005 and 2008, axillary artery was used as a cannulation site for cardiopulmonary bypass in 48 consecutive patients. At the same time, the aorta should be examined for aneurysmal dilatation, calci. Va ecmo cannulation venous cannula sites drainage rl femoral vein right ij right atrium arterial cannula sites reinfusion rl femoral artery rcca neonates axillary artery aorta. Our centre used a combined femoral and axillary perfusion strategy for the surgical treatment of type a aortic dissection. History the first operation performed using cardiopulmonary bypass and open cardiotomy was on april 5, 1951 by dr. Jan 26, 2019 keywords cannulation techniques, cardiopulmonary bypass step 1 surgical anatomy 1 ascending aorta cannulation sites on the ascending aorta should be as high as safely possible.
In addition, the success and relative ease of peripheral cannulation, among other technological advances, has permitted the development of. Cardiopulmonary bypass the annals of thoracic surgery. Open access protocol axillary versus innominate artery. Direct axillary cannulation for cardiopulmonary bypass youtube. Cardiopulmonary bypass is reestablished via the graft anastomosed to. Use of a dacron graft for cannulation has a number of advantages. Due to small vessel size, femoral cannulation is unsuitable for infants under 15 kg and, for larger patients, can result in hematomas, seromas, neuropathies, limb ischemia, and li. Cardiopulmonary bypass is commonly used in operations involving the heart. Axillary artery cannulation for cardiopulmonary bypass during. There are certain situations in redo cardiac surgery in adults where it may not be possible to use alternate arterial cannulation sites like the common femoral artery and axillary artery. However, axillary artery cannulation also involves some problems. To determine indications and results of axillary artery cannulation for cardiopulmonary bypass.
Fong interactive cardiovascular and thoracic surgery 759 ecomment. Direct axillary cannulation for cardiopulmonary bypass. Extrathoracic cannulation to establish cardiopulmonary bypass has been widely applied in recent years and includes. However, because of concerns regarding complications caused by retrograde perfusion, the number of surgeons who prefer using the axillary artery as the site for cannulation is increasing. In many operations, such as coronary artery bypass grafting cabg, the heart is arrested i.
Cannulation of the axillary artery for cardiopulmonary bypass is a dependable approach for procedures including reoperations, aortic dissections, and extensively diseased ascending aortas. Axillary artery cannulation with a dacron graft for surgery. Mean age was 62 11 years range 31 years 81 years, 33 patients 69% were males, and mean weight was 70 kg kg range 47 kg 103 kg. Nov 26, 2019 a cannulation strategy in surgery for stanford type a acute aortic dissection aaad is integral for patient survival. Few reports are available describing the role of the subclavian or axillary artery in the past. Axillary artery cannulation with a dacron graft for. Axillary artery cannulation for arterial inflow in patients with acute. The secondary objectives are to determine whether innominate artery cannulation for acp is noninferior to axillary artery cannulation with regards to postoperative 30 day mortality, and clinical and biomarker. An advantage of the cannulation of the axillary artery is that it is not necessary to recannulate the tube graft before reestablishing cardiopulmonary bypass. Innominate artery cannulation access in pediatric patients. The cannulation strategy in surgery for acute type a. Petechial and subcutaneous hemorrhage with blister.
Cannulation of the right axillary artery for surgery of acute type a aortic dissection. In 1 cannulation of the axillary artery is one possible means of establishing cardiopulmonary bypass during surgery of the ascending aorta and aortic arch. The axillary artery has become a popular site for arterial cannulation during cardiopulmonary bypass cpb when the ascending aorta cannot be used due to atherosclerosis, aneurysm, or dissection. Axillary artery was approached by infraclavicular incision and the cannula introduced in a 8 millimeter. Sixtyfive patients underwent cannulation of the axillary artery. Page 11 cannulation techniques central cannulation. The mean lowest core body temperature reached during circulatory arrest was 23. Malperfusion on initiation of cardiopulmonary bypass. Pdf axillary artery cannulation for cardiopulmonary bypass. Central venous cannulation for cardiopulmonary bypass is usually accomplished by cannulation of the right atrial appendage, the lateral wall of the right atrium, the superior vena cava, or the inferior vena cava. Recannulation of the axillary artery in aortic and complex. Right axillary artery cannulation in aortic valve replacement.
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