Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA.
Department of Surgical Diseases # 2, Kazan State Medical University, Kazan, Russia.
Eur J Cardiothorac Surg. 2018 Jun 1;53(6):1279-1281. doi: 10.1093/ejcts/ezx394.
Axillary artery cannulation is commonly used in thoracic aortic surgery, often utilizing a sidearm graft. Although our institutional preference is femoral cannulation, we use axillary cannulation in select cases with a 'dirty' aorta on computed tomography scan or intraoperative transoesophageal echocardiography. Since 2011, we have routinely used an open Seldinger-guided approach for axillary cannulation. Here, we report our experience with open Seldinger-guided technique, evaluating its safety and efficacy.
A retrospective analysis of our institutional database from 2011 to 2016 was performed to find cases of peripheral arterial cannulation for thoracic aortic surgery. We identified 404 consecutive patients who underwent peripheral arterial cannulation. Of these, 352 were femoral and 52 were axillary cannulations. All axillary cannulations were performed for ascending and/or arch surgery. The technique involves a surgical exposure of the artery which is then cannulated by guidewire inside a purse string without arterial incision.
Indications for surgery included aneurysm in 63.5% (33/52), dissection in 30.7% (16/52) and pseudoaneurysm in the remaining 5.8% (3/52). Hospital survival was 98.1% (51/52). There were no instances of axillary arterial injury or intraoperative malperfusion phenomena. No postoperative limb ischaemia or stroke was evident. No wound infections or late pseudoaneurysms were observed.
The open Seldinger-guided technique for axillary artery cannulation is safe and effective. We strongly recommend this technique, given its speed and simplicity. The vessel is not snared, thereby preserving distal arterial flow and minimizing the risk of acute limb ischaemia. Furthermore, the limited manipulation of the artery lowers the risk of local complications.
腋动脉插管常用于胸主动脉手术，常使用侧支移植物。虽然我们机构的偏好是股动脉插管，但在计算机断层扫描或术中经食管超声心动图显示主动脉“脏”时，我们会选择腋动脉插管。自 2011 年以来，我们常规使用开放式 Seldinger 引导方法进行腋动脉插管。在此，我们报告使用开放式 Seldinger 引导技术的经验，评估其安全性和有效性。
对 2011 年至 2016 年的机构数据库进行回顾性分析，以寻找胸主动脉手术外周动脉插管的病例。我们确定了 404 例连续接受外周动脉插管的患者。其中，352 例为股动脉插管，52 例为腋动脉插管。所有腋动脉插管均用于升主动脉和/或弓部手术。该技术包括动脉的手术暴露，然后通过导丝在荷包缝线内插管，而不进行动脉切开。
手术指征包括动脉瘤 63.5%（33/52）、夹层 30.7%（16/52）和假性动脉瘤 5.8%（3/52）。住院存活率为 98.1%（51/52）。无腋动脉损伤或术中灌注不良现象。无术后肢体缺血或中风。无伤口感染或迟发性假性动脉瘤。
开放式 Seldinger 引导腋动脉插管技术安全有效。鉴于其速度和简单性，我们强烈推荐这种技术。血管未被套扎，从而保留了远端动脉血流，最大限度地降低了急性肢体缺血的风险。此外，对动脉的有限操作降低了局部并发症的风险。
