Mastroroberto P, Chello M, Di Virgilio A, Onorati F, Merola S, Marchese A R, Renzulli A
Cardiovascular Surgery Unit, Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy.
J Cardiovasc Surg (Torino). 2006 Aug;47(4):457-60.
In this paper we report our clinical experience with extended utilization of axillary artery cannulation for cardiopulmonary bypass (CPB) and discuss the indications and the results of the procedure in terms of complications and usefulness.
Between January 1999 and May 2004, 26 patients underwent right axillary artery cannulation for CPB. Fifteen patients presented acute type A aortic dissection and were operated urgently. Axillary cannulation was also used in 11 elective cases: 3 reoperative coronary surgery, 3 valve redo-operations and 5 cases of aortic valve regurgitation+aneurysm of the ascending aorta.
All axillary artery cannulations were successful (21 direct and 5 with a side graft) without neurologic or vascular injuries to the right upper extremities. Hospital mortality was 7.7% and included 2 patients operated in an emergency procedure because of acute type A aortic dissection. In all cases, this cannulation site provided adequate perfusion, with a range of peak flows from 4.1 to 5.7 L/min.
Our preliminary results demonstrate that the right axillary artery may be considered an alternative cannulation site for achieving full CPB and providing antegrade flow, thus avoiding complications related to retrograde flow when femoral artery perfusion is performed. This safe and useful method may be used not only in aortic surgery but in other such complex cardiac procedures as redo-operations.
本文报告我们在体外循环（CPB）中延长使用腋动脉插管的临床经验，并从并发症和实用性方面讨论该手术的适应症及结果。
1999年1月至2004年5月期间，26例患者接受了用于CPB的右腋动脉插管。15例为急性A型主动脉夹层患者并接受了紧急手术。腋动脉插管也用于11例择期手术：3例再次冠状动脉手术、3例瓣膜再次手术以及5例主动脉瓣反流合并升主动脉瘤患者。
所有腋动脉插管均成功（21例直接插管，5例使用侧支移植物），未对右上肢造成神经或血管损伤。医院死亡率为7.7%，其中包括2例因急性A型主动脉夹层接受急诊手术的患者。在所有病例中，该插管部位均提供了充足的灌注，峰值流量范围为4.1至5.7升/分钟。
我们的初步结果表明，右腋动脉可被视为实现完全CPB并提供顺行血流的替代插管部位，从而避免在进行股动脉灌注时与逆行血流相关的并发症。这种安全且有用的方法不仅可用于主动脉手术，还可用于诸如再次手术等其他复杂心脏手术。
