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Axillary arterial catheterization for intraoperative and postoperative monitoring was successful in 90% of 87 attempts. Complications occurred in nine patients; there were eight hematomas, one of which was extensive. In the ninth patient, radial pulsations disappeared but returned after the catheter was withdrawn. There were no sequelae in any of these patients.
An aberrant axillary artery running deep to the brachial plexus during its course was observed. The brachial plexus in this case was formed by the fourth cervical nerve to the first thoracic nerve and the radial nerve received a small nerve bundle (accessory radial nerve root) from the posterior aspect of the lower trunk. The axillary artery passed between the lateral and the medial cords of the brachial plexus, the same as for an ordinary axillary artery. In addition, it passed between their posterior divisions, forming the posterior cord, and further ran between the radial nerve root and the accessory radial nerve root from deep to superficial. This axillary artery was recognized as the deep axillary artery, the same as the axillary artery we have reported previously. It was thought that the branches to the subscapularis and serratus anterior muscles, nutrient branch to the radial nerve root and the subscapular artery played important roles in its formation.
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An anomalous superficial ulnar artery was found during anatomical dissection in the right arm of an 83-year-old Japanese woman. It originated in the axillary artery, crossed over the median nerve, coursed ventral to the median nerve and the brachial artery, but superficial to the bicipital aponeurosis and the flexor muscles. At the palm it formed the superficial and deep palmar arches together with the branches of the radial artery. The brachial artery divided into the radial and common interosseous arteries in the cubital fossa.
A rare variation of the ulnar artery is presented on routine anatomical dissection in one male cadaver. The superficial ulnar artery was found to originate from the axillary artery. The free forearm flap is increasingly popular among plastic surgeons. As a result of this case, and a review of the literature to gain further knowledge of anatomical variations, it is advised that more attention should be paid clinically to this artery to prevent its injury.
A new technique of intra-arterial catheterization via the branch of left axillary artery is described. This provides relatively swift and safe insertion and long-term placement of an infusion catheter through the left thoracoacrominal artery without exposure of the left axillary artery, that was required by conventional methods. With our technique, the tip of the catheter tends to enter the distal axillary artery because of oblique angulation of the trunk of the thoracoacrominal artery. Therefore, the tip of the catheter in the axillary artery must be deflected using a deflecting guidewire, so that it will advance into the subclavian artery and then down to the descending aorta. The deflection guidewire can also be of help when the catheter tip migrates into either celiac or SMA. The selective catheterization has been successful in all twenty seven patients without preliminary selective left subclavian arteriography.
The axillary artery may be an alternative cannulation site for patients with diffused atherosclerosis, aortic dissection, and aneurysm. There are different techniques for axillary artery cannulation that can be performed easily with a transcutaneous approach. Small incision necessity, less dissection, and good wound healing are other advantages of this technique.
Hepatic artery catheterization via the axillary artery was performed successfully in 96% of 50 consecutive cases using a headhunter catheter. Direct intra-arterial hepatic infusion affords maximal patient ambulation, decreases hospitalization time, and permits direct perfusion of primary and secondary liver tumors. Displacement of the catheter from the hepatic artery was the most frequent complication.
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An axillary artery approach is occasionally necessary in the evaluation of the abdominal aorta and peripheral arteries in patients with severe and complicated arteriosclerotic disease. Difficulty may be encountered in directing the catheter into the descending aorta in patients with extremely tortuous and elongated aortic arches. Use of flow directed angiographic balloon catheters has made abdominal, pelvic, and lower extremity arteriography readily obtainable using an axillary approach when other methods failed and translumbar aortography was considered hazardous. This might be particularly useful in patients with high abdominal aortic occlusions, in anticoagulated patients, in patients with abdominal aortic grafts, and in some patients with small aortas displaced to the right.
Aneurysms of the axillary artery are rare and dangerous lesions that threaten the upper extremities with vascular and neurologic compromise. Most can be treated effectively with surgical excision and vascular grafting. We retrospectively assessed 4 axillary artery aneurysms upon which we operated from February 1998 through March 2004. Three patients were admitted to our clinic for symptomatic axillary masses. The remaining patient was transported to our clinic emergently due to massive hemorrhage of an enlarging axillary mass that occurred during biopsy of the mass at another hospital. In this patient, the ruptured axillary artery aneurysm was diagnosed by means of emergent upper-extremity selective angiography. All patients were treated surgically by means of aneurysmectomy and graft interpositioning--with polytetrafluoroethylene grafts in 2 patients and saphenous vein grafts in the other 2. Surgical treatment of axillary artery aneurysms is of importance in avoiding thromboembolism and ischemia, which in turn can lead to gangrene and amputation of the affected extremity. For this reason, operative management of such cases should not be delayed.
OBJECTIVE: Cardiopulmonary bypass via the axillary artery is frequently used especially in aortic dissections. With an increased use of this technique problems were recognized too. We describe the technical problems and complications associated with axillary artery cannulation. METHODS: Sixty-five patients underwent cannulation of the axillary artery. The indication for operation was acute aortic dissection type A in 57%, chronic aortic dissection in 8%, aortic aneurysm in 18%, pseudoaneurysm in 3%, and others in 14%. RESULTS: Technical problems and complications occurred in 14%, and in 11% the perfusion had to be switched to either femoral (n=5) or aortic cannulation (n=2). Arterial damage or dissection of the axillary artery or the aorta occurred in 0% of the sidegraft technique, whereas they were found in 9% with direct cannulation (P=n.s.). Cannulation problems or insufficient CPB flow due to a narrow vessel occurred in 0% of the sidegraft technique, whereas they were found in 4% with direct cannulation (P=n.s.). Malperfusion in aortic dissections occurred in 20% of the sidegraft technique, whereas they were found in 0% with direct cannulation (P=0.016). No postoperative complications related to axillary cannulation which were evaluated by clinical examination, such as brachial plexus injury, axillary artery thrombosis or local wound infection were observed. CONCLUSIONS: Although axillary artery cannulation is an attractive alternative to femoral cannulation there needs to be an alertness for technical problems. Different complications occur with either direct cannulation or the sidegraft technique and at present it remains the surgeons preference which technique for axillary artery cannulation is used.
BACKGROUND: Standard cannulation of the femoral artery in preparation for repair of a dissection involving the ascending aorta carries a high risk of malperfusion. Arterial perfusion through the right axillary artery is more likely to perfuse the true lumen and should be advantageous in acute dissections involving the ascending aorta. METHODS: Thirteen patients underwent repair of acute ascending aortic dissections and were perfused through the right axillary artery. All had deep hypothermic circulatory arrest. RESULTS: There was one mild intraoperative cerebrovascular accident with complete recovery and one operative death secondary to low cardiac output. There were no intraoperative problems with perfusion through the axillary artery, and there were no postoperative problems or complications involving the axillary artery, axillary vein, or brachial plexus. CONCLUSIONS: Arterial perfusion through the right axillary artery is a safe and effective means of more reliably perfusing the true lumen. In this regard, it may be superior to femoral artery perfusion and could lead to improved outcomes with repair of acute deBakey type I and II aortic dissections.
Extensive aortic disease, such as atherosclerosis with aneurysms or dissections that involve the ascending aorta, can complicate the choice of a cannulation site for cardiopulmonary bypass. To date, the standard peripheral arterial cannulation site has been the common femoral artery; however, this approach carries the risk of atheroembolism due to retrograde aortic perfusion, or it is undesirable because of severe iliofemoral disease. Arterial perfusion through the axillary artery provides sufficient antegrade aortic flow, is more likely to perfuse the true lumen in the event of dissection, and is associated with fewer atheroembolic complications. From September 2000 through March 2004, 27 patients underwent right axillary artery cannulation for acute ascending aortic dissection (n = 16), ascending aortic aneurysm (n = 9), or coronary artery bypass grafting (n = 2). Direct artery cannulation was performed in the first 4 patients, and the last 23 patients were cannulated through a longitudinal arteriotomy via an 8-mm woven Dacron graft. Seventeen patients underwent hypothermic circulatory arrest and antegrade cerebral perfusion. Two patients died intraoperatively: one due to low cardiac output and one due to diffuse bleeding. One patient suffered mild right-arm paresthesia postoperatively, but recovered completely. Axillary artery cannulation was successful in all patients; it provided sufficient arterial flow, and there were no intraoperative problems with perfusion. In the presence of extensive aortic or iliofemoral disease, arterial perfusion through the axillary artery is a safe and effective means of providing sufficient arterial inflow during cardiopulmonary bypass. In this regard, it is an excellent alternative to standard femoral artery cannulation.
Radiation injury to subclavian and axillary arteries is a rare and late complication of radiotherapy. Until recently it has been treated almost exclusively by carotid-brachial bypass surgery. We report three cases who presented with severe upper limb ischaemia following previous axillary radiotherapy for breast carcinoma. One patient with an axillary artery occlusion failed angioplasty and required bypass surgery. A further patient with an axillary artery occlusion was successfully managed by the percutaneous placement of an arterial stent. The third patient with an isolated axillary artery stenosis responded to balloon angioplasty. All three patients remained asymptomatic. Percutaneous angioplasty and stent placement, where necessary, are appropriate first choice treatment for delayed radiation stenosis and occlusion in upper limb ischaemia.
Severe atherosclerotic disease of the ascending aorta is one of the risk factors of dissection of the ascending aorta and cerebral embolism during cardiac operations with cardiopulmonary bypass. Aortic dissection is rare, but once it happens, the mortality rate is high. For the patient with severely atherosclerotic or strongly calcified aorta, we should avoid cannulation into the aorta or clamping of it. In this case, we experienced aortic dissection although we chose the arterial cannulations into the axillary arteries because of the strong calcification of the ascending aorta and the abdominal aorta. The dissection was caused by the cannulation into the axillary artery. Transesophageal echocardiography (TEE) showed the dissection during the operation and the ascending aorta was replaced soon. Early diagnosis and treatment saved the patient. This case showed the following points: 1) cannulation into an axillary artery is not always safe; 2) TEE is very useful to detect the complicated dissection during operation; 3) replacement of the ascending aorta alone can be one of the choices for the treatment of aortic dissection caused by cannulation into an axillary artery.
Bilateral axillary arterial cannulation for selective cerebral perfusion might minimize cerebral embolic complications during surgery on the ascending aorta and aortic arch. From March 2002 through February 2004, bilateral axillary arterial perfusion was applied in 12 consecutive patients (mean age, 61.3 years). Operative procedures were total arch replacement in 8 patients, hemiarch replacement in 1, and ascending aorta replacement in 3. Antegrade selective cerebral perfusion was established through vascular grafts anastomosed to the bilateral axillary arteries and a perfusion catheter placed directly into the left carotid artery. Bilateral axillary arterial perfusion through the grafts was successful in all patients. There were no early or late deaths and no incidence of neurologic deficit. There were no complications related to cannulation of the axillary arteries. Bleeding, temporary renal failure, acute respiratory distress syndrome, and graft infection occurred in one patient each; all recovered from these complications. Bilateral axillary arterial perfusion is feasible and effective for brain protection during surgery on the ascending aorta and aortic arch.
The third part of the axillary artery unilaterally divides into two major arterial stems, named according to their localization as deep brachial artery and superficial brachial artery (brachial artery). The deep brachial artery gives off the posterior circumflex humeral artery, anterior circumflex humeral artery, subscapular artery, and profunda brachii artery. It continues its course in the arm lateral to the median nerve and terminates by giving a minute twig to the radial artery. The superficial brachial artery is larger in caliber than the deep brachial artery and gives no branches in the arm region. In the cubital fossa it gives the ulnar and the radial arteries. This case is a variant of the axillary artery that has been rarely (0.12-3.2%) documented in the literature. Accurate knowledge of the normal and variant arterial anatomy of the axillary artery is important for clinical procedures in this region. Clin. Anat. 13: 66-68, 2000.