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• W2141781163 abstract "To the Editor: We read the report of Takayama and colleagues1Takayama H. Smith C.R. Bowdish M.E. Stewart A.S. Open distal anastomosis in aortic root replacement using axillary cannulation and moderate hypothermia.J Thorac Cardiovasc Surg. 2009; 137: 1450-1453Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar about the successful management of aortic root replacement with axillary artery cannulation and open distal anastomosis technique. For ascending and aortic arch repair, we use a similar cannulation site, the right brachial artery. We previously published our results of 104 arch repair cases that we performed with low-flow antegrade cerebral perfusion through the right brachial artery and with an open distal anastomosis technique during moderate hypothermia.2Tasdemir O. Sarıtas A. Kucuker S. Ozatik M.A. Sener E. Aortic arch repair with brachial artery perfusion.Ann Thorac Surg. 2002; 73: 1837-1842Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar We congratulate the authors for their excellent results, but we would like to remind them that neither axillary nor brachial artery cannulation is totally safe and reliable. There are literature reports about the pitfalls of axillary artery cannulation, including arterial injury, new aortic dissection, compartment syndrome/arm ischemia, brachial plexus injury, inadequate cardiopulmonary bypass flow, and malperfusion.3Schachner T. Nagiller J. Zimmer A. Laufer G. Bonatti J. Technical problems and complications of axillary artery cannulation.Eur J Cardiothorac Surg. 2005; 27: 634-637Crossref PubMed Scopus (118) Google Scholar In a patient with acute type I aortic dissection, we recently experienced a complication of axillary artery cannulation that we could not have realized initially. The patient's brachial artery diameter was very small, and therefore we preferred axillary artery cannulation with a side-graft anastomosis. The axillary arterial wall looked normal, and its flow seemed to be adequate. As soon as we started cardiopulmonary bypass, the pressure in the arterial lines exceeded normal ranges, and bleeding occurred around the axillary artery cannula. We decided that our cannula was in the false lumen. We quickly switched the inflow cannula to the innominate artery. The patient did wake up without any neurological deficit. For aortic dissections extending into the axillary artery, it is possible for the surgeon not to realize this situation, and he or she might end up cannulating the false lumen. One should be very cautious about the line pressure at the initiation of cardiopulmonary bypass and should be ready for alternative techniques, if necessary. We would like to remind the authors of another condition in which axillary artery cannulation is not safe or even contraindicated. An aberrant right subclavian artery is an anatomic variation that is more common than we think, with a prevalence of 0.4% to 2%. The aberrant right subclavian artery originates from the proximal descending aorta, and patients with this anomaly are typically asymptomatic.4Makaryus A.N. Boxt L.M. Magnetic resonance imaging.in: Coselli J.S. Lemaire S.A. Aortic arch surgery: principles, strategies and outcomes. Wiley-Blackwell, Hoboken, NJ2008: 65-66Google Scholar, 5Svensson L.G. Congenital anomalies in adults.in: Coselli J.S. Lemaire S.A. Aortic arch surgery: principles, strategies and outcomes. Wiley-Blackwell, Hoboken, NJ2008: p.252-p.253Google Scholar It is clear that the inflow will route to the descending aorta with right axillary artery cannulation in such a patient, and therefore alternative cannulation sites are to be used. Direct cannulation of the right, the left, or both carotid arteries can be used in this situation. We would like to underline that the existence of an aberrant right subclavian artery is not that rare and must be kept in mind. We conclude that in these complex surgical approaches, the ideal method of arterial access is not identical and changes individually. Perfusion, neuroprotection, and open graft replacement techniques depend on anatomic considerations and prudential judgments. Open distal anastomosis in aortic root replacement using axillary cannulation and moderate hypothermiaThe Journal of Thoracic and Cardiovascular SurgeryVol. 137Issue 6PreviewRecent advance in surgical technique facilitates more aggressive approaches for thoracic aortic diseases. We sought to address the outcomes of our strategy of open distal anastomosis with aortic root replacement using axillary cannulation and moderate hypothermia. Full-Text PDF Reply to the EditorThe Journal of Thoracic and Cardiovascular SurgeryVol. 139Issue 3PreviewWe have read the article by Dr Küçüker and his colleagues with great interest. They should be congratulated on their excellent clinical outcome of arch repair using right brachial artery cannulation.1 Their technique achieves the same goal as the axillary artery cannulation technique. Although the brachial artery might be easier to access, its size might occasionally prevent it from being used. Monitoring of the antegrade selective perfusion pressure, which we believe to be a critical component of assessment of the cerebral perfusion, might be easier with axillary cannulation with an arterial pressure line placed in the right radial artery. Full-Text PDF" @default.
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• W2141781163 title "Safety of axillary artery cannulation" @default.
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