Cannulation of the Axillary Artery with a Side Graft for Aortic Surgery: Is the Remnant Graft Stump Negligible?

Seung Keun Yoon ¹, Yong Han Kim ², Keon Hyun Jo ¹, Hwan Wook Kim ¹, Do Yeon Kim ¹

¹ Seoul St Marys Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (South); ² Incheon St Marys Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea (South);

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – C

Abstract

Objective: Despite increased the use of right axillary artery for alternative perfusion site in case of aortic surgery, complications associated with cannulation of the right axillary artery are low and sometimes neglected. The purpose of this study was to investigate the morbidities focusing on characteristics of neurologic complaints and particularly in relation to direction of the remnant graft stump after axillary cannulation with a side graft.

Methods: Between November 2010 and March 2016, 161 consecutive patients (except 2 patients with direct cannulation) underwent right axillary artery cannulation for cardiopulmonary bypass with a side graft technique at our institution, mainly in case of Type A aortic dissection or ascending aortic aneurysm. The preoperative and postoperative data were collected and analyzed retrospectively.

Results: There were 9 (5.5%) mortalities out of the total 161 patients during follow-up, none of which could be attributed to right axillary artery cannulation. Hemi-arch replacement was performed in 125 patients (76.7%) and partial or total arch replacement in 35 (21.5%), along with additional aortic root replacement or aortic valve surgery in 32 and 17 patients, respectively. Complications related directly to the right axillary artery cannulation using a side graft technique were rare and occurred in 18 patients. Most commonly, abnormal neurologic symptoms of the upper limb occurred in 15 patients (9.3%), brachial plexus injury resulting to motor dysfunction in 2 (1.2%), and focal arterial dissection in cannulation site on the right axillary artery was found in 1 patient on postoperative computed tomography.

Conclusions: Despite increased use of cannulation of the right axillary artery for arterial inflow during cardiopulmonary bypass for aortic surgery with encouraging results, more attention should be focused on the negligible neurologic symptoms associated with the remnant graft stump left behind after axillary cannulation with a side graft.