Neri E, Massetti M, Capannini G, Carone E, Tucci E, Diciolla F, Prifti E, Sassi C
Istituto di Chirurgia Cardiovascolar Universitá agli Studi di Siena, Italy.
J Thorac Cardiovasc Surg. 1999 Aug;118(2):324-9. doi: 10.1016/S0022-5223(99)70223-0.
Femoral arteries are the preferred site of peripheral cannulation for arterial inflow in type A aortic dissection operations. The presence of aortoiliac aneurysms, severe peripheral occlusive disease, atherosclerosis of the femoral vessels, and distal extension of the aortic dissection may preclude their utilization. Axillary artery cannulation may represent a valid alternative in these circumstances.
Between January 15, 1989, and August 20, 1998, in our institution, 22 of 152 operations (14.4%) for acute type A aortic dissection were performed with the use of the axillary artery for the arterial inflow. Axillary artery cannulation was undertaken in the presence of femoral arteries bilaterally compromised by dissection in 12 patients (54.5%), abdominal aorta and peripheral aneurysm in 5 patients (22.7%), severe atherosclerosis of both femoral arteries in 3 patients (13. 6%), and aortoiliac occlusive disease in 2 patients (9.1%). In all patients, distal anastomosis was performed with an open technique after deep hypothermic circulatory arrest. Retrograde cerebral perfusion was used in 9 patients (40.9%).
Axillary artery cannulation was successful in all patients. The left axillary artery was cannulated in 20 patients (90.9%), and the right axillary artery was cannulated in 2 patients (9.1%). Axillary artery cannulation followed an attempt of femoral artery cannulation in 15 patients (68. 2%). All patients survived the operation, and no patient had a cerebrovascular accident. No axillary artery thrombosis, no brachial plexus injury, and no intraoperative malperfusion were recorded in this series. Two patients (9.1%) died in the hospital of complications not related to axillary artery cannulation.
In patients with type A aortic dissection in whom femoral arteries are acutely or chronically diseased, axillary artery cannulation represents a safe and effective means of providing arterial inflow during cardiopulmonary bypass.
在A型主动脉夹层手术中，股动脉是外周插管进行动脉流入的首选部位。存在主髂动脉瘤、严重的外周闭塞性疾病、股血管动脉粥样硬化以及主动脉夹层的远端延伸可能会妨碍其使用。在这些情况下，腋动脉插管可能是一种有效的替代方法。
1989年1月15日至1998年8月20日期间，在我们机构进行的152例急性A型主动脉夹层手术中，有22例（14.4%）使用腋动脉进行动脉流入。12例患者（54.5%）因夹层导致双侧股动脉受损，5例患者（22.7%）因腹主动脉和外周动脉瘤，3例患者（13.6%）因双侧股动脉严重动脉粥样硬化，2例患者（9.1%）因主髂闭塞性疾病而进行腋动脉插管。所有患者在深度低温循环停止后采用开放技术进行远端吻合。9例患者（40.9%）使用了逆行脑灌注。
所有患者腋动脉插管均成功。20例患者（90.9%）插管左腋动脉，2例患者（9.1%）插管右腋动脉。15例患者（68.2%）在尝试股动脉插管后进行了腋动脉插管。所有患者手术存活，无患者发生脑血管意外。本系列中未记录腋动脉血栓形成、臂丛神经损伤及术中灌注不良情况。2例患者（9.1%）死于与腋动脉插管无关的并发症。
在股动脉存在急性或慢性疾病的A型主动脉夹层患者中，腋动脉插管是体外循环期间提供动脉流入的一种安全有效的方法。
