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Eur J Cardiothorac Surg 2009;35:913-914. doi:10.1016/j.ejcts.2009.01.049
Copyright © 2009, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Giuseppe Zattera
Pasquale Totaro
Andrea Maria D’Armini
Mario Vigano
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How-to-do-it

Deltoido-pectoralis approach to axillary vessels for full-flow cardiopulmonary bypass

Giuseppe Zatteraa, Pasquale Totaroa,*, Andrea Maria D’Arminia,b, Mario Viganoa,b

a IRCCS "Fondazione Policlinico S Matteo", Pavia, Italy
b University School of Medicine, Pavia, Italy

Received 5 December 2008; received in revised form 25 January 2009; accepted 29 January 2009.

* Corresponding author. Address: Via San Vincenzo, 38, 20123 Milan, Italy. Tel.: +39 349 8465085; fax: +39 02 8053331. (Email: ptotaro{at}yahoo.com).

Axillary artery has been proposed as a safe and effective alternative for arterial cannulation in surgical procedures involving ascending aorta and/or aortic arch, and is nowadays the site of choice in many centres. Advantages of axillary artery cannulation include antegrade flow and the possibility of selective mono-hemispherical brain perfusion during circulatory arrest. Experiences with the axillary vein cannulation, however, are scarce. Here we report our preliminary experience with axillo-axillary cardiopulmonary bypass, through both axillary artery and vein cannulation (using echo-guided Seldinger technique) at deltoido-pectoralis groove. We have used such an approach in 5 cases of redo surgery on ascending aorta and we have not had any inconvenience during cardiopulmonary bypass. Full flow was maintained in all patients (in 2 with vacuum assisted drainage) including 2 cases with deep hypothermic circulatory arrest. In conclusion such an approach seems to be feasible and effective and can be safely performed providing that accurate TE echo monitoring is provided.

Key Words: Axillary artery • Axillary vein • Cardiopulmonary bypass






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Copyright © 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.