Bichell D P, Balaguer J M, Aranki S F, Couper G S, Adams D H, Rizzo R J, Collins J J, Cohn L H
Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Ann Thorac Surg. 1997 Sep;64(3):702-5. doi: 10.1016/s0003-4975(97)00636-x.
Peripheral arterial and venous cannulation for cardiopulmonary bypass is used increasingly for patients undergoing minimally invasive cardiac operations, complex reoperations, or repair of aortic dissection or aneurysm, and for patients with extensive arteriosclerotic aortic disease in whom aortic cannulation is a prohibitive embolic risk. The common femoral artery and vein are most commonly used for peripheral cannulation, but these sites may be predisposed to complications, primarily because the femoral vessels are commonly involved with arteriosclerotic disease. We have recently begun to use the axillary artery and axillary vein as alternative cannulation sites, achieving full cardiopulmonary bypass, providing antegrade aortic flow, and avoiding many of the complications associated with other sites.
Seven patients with peripheral vascular or aortic disease, or both, prohibiting safe aortic or femoral cannulation underwent cardiopulmonary bypass through axillary artery and axillary vein cannulation, approached through a small single subclavicular incision.
All patients were successfully cannulated and axilloaxillary cardiopulmonary bypass was possible without the need for additional cannulas. All axillary vessels were closed primarily without complication.
For an expanding population of patients with peripheral vascular and aortic disease, axilloaxillary bypass is a safe and practical alternative to aortic or femoral cannulation.
对于接受微创心脏手术、复杂再次手术、主动脉夹层或动脉瘤修复的患者，以及主动脉插管存在极高栓塞风险的广泛动脉硬化性主动脉疾病患者，越来越多地采用外周动脉和静脉插管进行体外循环。股总动脉和股静脉最常用于外周插管，但这些部位可能易发生并发症，主要是因为股血管通常会累及动脉硬化性疾病。我们最近开始使用腋动脉和腋静脉作为替代插管部位，实现了完全体外循环，提供了顺行性主动脉血流，并避免了许多与其他部位相关的并发症。
7例患有外周血管疾病或主动脉疾病，或两者兼有的患者，因无法安全进行主动脉或股动脉插管，通过单一小锁骨下切口经腋动脉和腋静脉插管进行体外循环。
所有患者均成功插管，且无需额外插管即可进行腋腋体外循环。所有腋血管均一期缝合，无并发症。
对于外周血管和主动脉疾病患者群体不断扩大的情况，腋腋旁路是主动脉或股动脉插管的一种安全且实用的替代方法。
