Experience With the Axillary Artery as an Arterial Cannulation Site in Patients With Acute Type A Aortic Dissection.

BACKGROUND: The optimal arterial cannulation site in patients undergoing surgical management of acute type A aortic dissection (ATAAD) remains controversial. The axillary artery is rarely involved in the dissection process, provides antegrade flow in the descending aorta and minimises intraoperative malperfusion. The purpose of this study is to evaluate a single surgeon's experience of axillary artery cannulation for ATAAD repair.

METHODS: All consecutive patients over a 15-year period having surgical repair of ATAAD were included in this study.

RESULTS: There were 55 patients with a mean age of 67years. The most common risk factors were hypertension (83.6%), connective tissue disease (7.3%) and a bicuspid aortic valve (7.3%). Axillary artery cannulation was performed on 50 patients (90.9%) and was contraindicated in the remaining five patients. Forty-nine patients survived to 30days with a 10.9% 30-day mortality rate. There was one confirmed stroke (1.8%) and no new malperfusion noted postoperatively. There were no major axillary artery complications or new dissection related to cannulation. We attribute these results, which are lower than those reported in the International Registry of Acute Aortic Dissection (IRAD) database, to axillary artery cannulation providing antegrade flow in the descending aorta from the outset and reducing intraoperative malperfusion. We believe this technique offers a cerebroprotective advantage and also facilitates selective antegrade cerebral perfusion (SACP) when aortic arch replacement is required.

CONCLUSION: We believe the axillary artery is the ideal cannulation site of ATAAD and helps to reduce mortality and neurological complications in this high-risk group of patients.