Bowers Philippa Jane Temple, Mathur Manu Narain
Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.
J Card Surg. 2017 Jul;32(7):422-425. doi: 10.1111/jocs.13163. Epub 2017 Jun 19.
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. This study reports our experience with reusing the axillary artery for cardiopulmonary bypass during complex aortic and cardiac surgical procedures.
This was a retrospective review of a single surgeon's experience of recannulating the axillary artery for redo operations in complex aortic surgery. Seven patients over a 7-year period have undergone recannulation of their axillary arteries. The old Dacron graft stump was either excised and a new graft was anastamosed to the axillary artery or a new end-to-side anastamosis was performed either proximal or distal to the original graft stump.
There were no deaths, strokes, or postoperative complications. In one patient, axillary cannulation was aborted intraoperatively due to high-line pressures, suggesting a local dissection. The other patients all had adequate perfusion via the recannulated axillary artery and there were no complications associated with its reuse.
Recannulation of the axillary artery is easily achievable and should be considered in redo aortic and complex cardiac surgery.
在主动脉夹层以及升主动脉和主动脉弓动脉瘤疾病的手术过程中，腋动脉插管已被用作体外循环的替代部位。本研究报告了我们在复杂主动脉和心脏手术中重复使用腋动脉进行体外循环的经验。
这是一项对单一外科医生在复杂主动脉手术中再次插管腋动脉进行再次手术经验的回顾性研究。在7年时间里，有7例患者接受了腋动脉再次插管。旧的涤纶移植血管残端要么被切除，将新的移植血管与腋动脉吻合，要么在原移植血管残端的近端或远端进行新的端侧吻合。
无死亡、中风或术后并发症发生。1例患者术中因管路压力过高导致腋动脉插管失败，提示局部夹层形成。其他患者通过再次插管的腋动脉均获得了充足的灌注，且再次使用腋动脉未出现相关并发症。
腋动脉再次插管很容易实现，在再次主动脉手术和复杂心脏手术中应予以考虑。
