Direct Right Axillary Artery Cannulation as First Choice Strategy during Aortic Surgery Procedures: Results from a Single Experienced Surgical Centre

Objectives: Since early nineties axillary artery has been proposed as alternative to femoral artery for peripheral arterial cannulation during cardiopulmonary bypass (CPB) in aortic surgery. The aim of this study is to report our single-centre experience using direct axillary artery cannulation during aortic surgery. Methods: One hundred consecutive patients, undergoing aortic surgery using direct axillary artery cannulation were enrolled. Patient population ranged between 29 to 87 years and mean age was 65 ± 13 years. Seventy-seven patients (77%) underwent scheduled complex surgical procedure and 23 patients (23%) underwent emergent surgical procedure. Sixteen patients, furthermore, have had a previous cardiac surgery procedure. Results: CPB management using direct axillary artery cannulation was satisfactory in all cases. No case of malperfusion (cerebral and/or visceral) was reported. Out of 100 patients undergoing direct cannulation of axillary artery, no major complications related to the site or the technique of the cannulation were recorded. Local minor complications were reported in 6 patients (6%). In all 6 patients such complications were transitory and there was no residual compromission at the discharge. Overall 30-days mortality was 16%. Twenty-two patients (22%) conversely were discharged directly from intensive care unit (ICU) to chronic rehabilitation center. Sixty-seven patients (67%) were successfully discharged home. Conclusions: Our experience clearly shows that direct axillary artery cannulation is a safe, effective and reproducible technique for arterial cannulation during complex surgical procedures involving thoracic aorta. We do support such approach as a first choice strategy in such circumstances.