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At least 73 records · Page 4Linked to original sources
PubMed2005

Recannulation of the right axillary artery for complex aortic surgeries.

Owing to the increased use of the axillary artery for arterial inflow during cardiopulmonary bypass, patients with previous cannulation at this site who require reoperation will be encountered more and more frequently. We describe the cases of 2 patients who required recannulation of the axillary artery for complex reoperations of the thoracic aorta. The technique and pitfalls are described. The decision was made to reuse the previous cannulation site at the right axillary artery due to the presence of large pseudoaneurysms in proximity to the sternum. The old 8-mm Dacron stump was found and excised, and a new 8-mm Dacron graft was sutured to the right axillary artery for arterial inflow. In the 1st patient, the Dacron side-graft enabled insertion and subsequent inflation of an EndoClamp within the Dacron graft of the ascending aorta, which obviated profound hypothermia. In the 2nd patient, recannulation of the right axillary artery enabled us to open the sternum at low flow using moderate hypothermia, given that antegrade cerebral perfusion was easily accessible in the event of a more prolonged arrest time. Both patients recovered fully, without neurovascular complications secondary to the recannulation of the right axillary. Recannulation of the right axillary artery is safe during complex reoperation of the thoracic aorta. It avoids retrograde perfusion in the often-diseased descending thoracic aorta. Furthermore, sternal reentry may be performed under moderate hypothermia, because antegrade cerebral perfusion can be initiated with ease.

Aged↗
PubMed2003

[Axillary artery cannulation for extracorporeal circulation].

BACKGROUND: When the ascending aorta and the femoral artery cannot be used for extracorporeal circulation, an emerging alternative is the use of axillary artery. AIM: To report the experience using the axillary artery for extracorporeal circulation. PATIENTS AND METHODS: Between November 1998 and May 2002, 22 patients (14 male) were operated with extracorporeal circulation, cannulating the axillary artery. Briefly, an incision is made below the middle third of the clavicle and a cut is made on major pectoris muscle. Minor pectoris muscle is retracted and axillary artery is exposed. It is cannulated directly or with the aid of a prosthesis. RESULTS: Right axillary artery was used in 21 patients and in 20 it was cannulated with the aid of a prosthesis. Mean flow was 4.5 +/- 0.6 l/min. The most common indications were aortic dissection or aneurysms. The most common procedures done, were ascending aorta replacement in 8 cases and replacement of ascending aorta and aortic arch in 5. Thirty five percent of operations were emergencies and 32% were reoperations. In 15 patients (68%), a circulatory arrest was done. Of these, retrograde brain perfusion was used in 9, antegrade brain perfusion through the same axillary artery was used in 2 and mixed perfusion was used in 2. One patient had a complication related to the axillary cannulation. None had cerebrovascular accidents or thromboembolic complications. Two patients died in the postoperative period. Patients were followed up to 42 months after the procedure and no secondary complications of the cannulation were detected. CONCLUSIONS: When the ascending aorta and the femoral artery cannot be used, axillary artery is a good alternative for extracorporeal circulation.

Adult↗
PubMed2004

Axillary artery access for interventional procedures.

PURPOSE: To evaluate axillary artery access for the interventional treatment of carotid or splanchnic arteries that have angulated takeoff or complex anatomy when larger catheters (up to 9 F) are needed. TECHNIQUE: The axillary artery approach was used to treat the left internal carotid artery (ICA) in 3 patients (2 angulated takeoffs and 1 bovine arch) and a celiac axis aneurysm. An 8-F, 45-cm-long introducer sheath was inserted for the carotid procedures, whereas a 9-F, 90-cm sheath was chosen for the celiac aneurysm. Cerebral protection and stenting were successfully performed in all carotid patients; an 8x40-mm stent-graft was implanted to exclude the celiac artery aneurysm. An 8-F vascular closure device was used in the axillary arteries; hemostasis was immediate, and no hematoma or other complications were recorded in follow-up. CONCLUSIONS: This preliminary experience revisits the axillary approach as an alternative access route for interventional procedures. In association with a vascular closure device, this approach should be considered as a useful and safe option for those interventional procedures in which larger sheaths or catheters are required to cope with difficult arterial anatomies.

Aneurysm↗
PubMed2002

Variations in the subclavian-axillary arterial system.

OBJECTIVE: The objective of this study is to report on the subclavian axillary arterial system variations observed in the dissecting room. METHODS: The morphological study of 106 formalin fixed upper limbs of adult human cadavers of both sexes was carried out at human anatomy laboratory of College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia over a 5 year period, to observe the distribution pattern of the subclavian axillary arterial system. RESULTS: The arterial variations in the upper extremities are quite common and may occur at the level of the thoracic outlet, axilla, arm, cubital fossa and the hand. In the present study, the anomalous topographic pattern of the subclavian axillary arterial system was revealed in 7.5% of the cadavers, whereas 92.5% exhibited classical pattern of the regional arterial anatomy. The study showed: 1. An aberrant right subclavian artery arising from the arch of aorta, distal to the left subclavian artery. 2. A bilateral common subscapular-circumflex humeral trunk (3.8%) emerging from the 3rd part of the axillary artery (branching into the circumflex humeral and thoracodorsal arteries. 3. A bilateral thoracohumeral trunk arising from the 2nd part of the axillary artery (1.9%) and branching into the lateral thoracic, circumflex humeral, subscapular and thoracodorsal arteries. These anomalies were accompanied by anomalous insertion of flexor digitorum superficialis muscle, a bilateral digastric muscle formed by the abductor pollicis longus and brevis, and an anomalous formation of median nerve by 3 roots. CONCLUSION: The aberrant right subclavian artery associated with right non-recurrent laryngeal nerve and variant branching pattern of the axillary artery are of interest to anatomists, surgeons and radiologists and suggested that these anomalies must be evaluated pre-operatively.

Adult↗
PubMed1989

Axillary arterial monitoring of pediatric patients.

Use of the axillary artery for hemodynamic monitoring has gained acceptance in critically ill adults. However, there is little information concerning the safety and complications of such catheters in the pediatric population. Sixteen pediatric patients who had axillary lines placed for pressure monitoring were evaluated for neurologic and vascular function, by comparing the arm with the axillary line with the contralateral arm. There were no major complications during axillary artery monitoring. After decannulation, systolic blood pressure did not differ between arms. In a pediatric critical care environment with skilled ongoing nursing care, the axillary artery can be used as a site for intraarterial monitoring in pediatric patients without a detrimental effect on concurrent or future blood pressure monitoring.

Adolescent↗
PubMed1995

Cannulation of the axillary artery in critically ill newborn infants.

UNLABELLED: The axillary artery has been successfully cannulated in critically ill adult and paediatric patients. There is little information about experience with this technique in neonates. We report the use of axillary cannulation in 62 mechanically ventilated neonates with birth weight from 750 to 3800 g (mean 1950 g). The axillary artery was catheterized with 24 or 22 gauge teflon catheters by means of the catheter-over-a-needle technique. Arterial access was used for blood pressure monitoring, blood sampling and in seven cases for blood removal during exchange transfusions. Cannulae were removed when the fraction of inspired oxygen (FIO2) was less than 0.3. During cannulation capillary refill, radial artery pulse and neurological status of the arm were checked daily. The mean period of cannulation was 4.1 days (1-10 days). During cannulation and after catheter removal there were no complications related to the chosen vessel e.g. no change in the skin colour, skin warmth, capillary refill and the quality of the radial pulse. No changes in the motor activity of the limb on the cannulated side were observed. CONCLUSION: Axillary artery cannulation is a useful alternative for establishing an arterial access in ventilated neonates. Further studies are needed to evaluate the long-term consequences of this technique.

Axillary Artery↗
PubMed2002

Variations in the subclavian-axillary arterial system.

OBJECTIVE: The objective of this study is to report on the subclavian axillary arterial system variations observed in the dissecting room. METHODS: The morphological study of 106 formalin fixed upper limbs of adult human cadavers of both sexes was carried out at human anatomy laboratory of College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia over a 5 year period, to observe the distribution pattern of the subclavian axillary arterial system. RESULTS: The arterial variations in the upper extremities are quite common and may occur at the level of the thoracic outlet, axilla, arm, cubital fossa and the hand. In the present study, the anomalous topographic pattern of the subclavian axillary arterial system was revealed in 7.5% of the cadavers, whereas 92.5% exhibited classical pattern of the regional arterial anatomy. The study showed: 1. An aberrant right subclavian artery arising from the arch of aorta, distal to the left subclavian artery. 2. A bilateral common subscapular-circumflex humeral trunk (3.8%) emerging from the 3rd part of the axillary artery (branching into the circumflex humeral and thoracodorsal arteries. 3. A bilateral thoracohumeral trunk arising from the 2nd part of the axillary artery (1.9%) and branching into the lateral thoracic, circumflex humeral, subscapular and thoracodorsal arteries. These anomalies were accompanied by anomalous insertion of flexor digitorum superficialis muscle, a bilateral digastric muscle formed by the abductor pollicis longus and brevis, and an anomalous formation of median nerve by 3 roots. CONCLUSION: The aberrant right subclavian artery associated with right non-recurrent laryngeal nerve and variant branching pattern of the axillary artery are of interest to anatomists, surgeons and radiologists and suggested that these anomalies must be evaluated pre-operatively.

Journal Article↗
PubMed2002

Transpulmonary thermodilution cardiac output measurement using the axillary artery in critically ill patients.

STUDY OBJECTIVE: To compare cardiac output (CO) as measured by the arterial thermodilution technique using only a central venous catheter and an arterial catheter inserted into the axillary artery, with conventional CO measurement with thermodilution using a pulmonary artery (PA) catheter (PAC). DESIGN: Prospective clinical study in which each patient served as his/her own control. SETTING: General ICU of a large tertiary-care teaching hospital. PATIENTS: 22 patients who required invasive hemodynamic monitoring in the ICU. INTERVENTIONS AND MEASUREMENTS: CO measurements made using the PAC (COpa) were compared to bolus arterial thermodilution measurements (COax). The significance of acute changes in the continuous CO measurements during acute hemodynamic episodes was observed. MAIN RESULTS: The correlation between the two techniques (COpa and COax) was R(2) = 0.82. There was a tendency for 5% overestimation of COpa by the COax. The SEM% (SEM/average CO) for COax and COpa was 2.6% and 3.2%, respectively. The bias between measurements was 0.27 +/- 0.67 L/min, and the limits of agreement (mean difference +/- 2 SD) from minus 1.07 L/min to 1.63 L/min. CONCLUSIONS: In critically ill patients, in whom the measurement of CO is required, arterial thermodilution, using a central vein and the axillary artery is accurate and reproducible.

Adult↗
PubMed2006

Direct versus side-graft cannulation of the right axillary artery for antegrade cerebral perfusion.

Antegrade selective cerebral perfusion through the right axillary artery has proved to be a safe and effective method for cerebral protection in aortic surgery. In this study, we prospectively evaluated the techniques of direct right axillary artery cannulation (Group 1) and right axillary artery side-graft cannulation (Group 2), investigated cannulation-related complications, and determined the hemodynamic advantages and disadvantages of both cannulation techniques. Sixty-eight patients underwent surgery from April 2001 through August 2004 with the diagnoses of ascending and aortic arch aneurysms (10 patients), type A aortic dissection (56 patients), and aortic pseudoaneurysm (2 patients). There were 22 patients in Group 1 (33.4%) and 46 patients in Group 2 (67.6%). The antegrade selective cerebral perfusion flow was 500 to 700 mL/min in Group 1, whereas in Group 2 the flow was adjusted in accordance with the mean right radial arterial pressure, which was 50 mmHg. There was no significant difference between the groups in antegrade selective cerebral perfusion times, but the transient neurologic dysfunction rate (4 of 22 patients in Group 1 vs 1 of 42 in Group 2) was significantly lower in Group 2 (P =0.035). In Group 1, axillary artery dissection occurred in 2 patients (9%), and postoperative arm ischemia occurred in 1 patient (4.5%). These complications were not seen in Group 2 (P =0.031). The side-graft cannulation technique may be more acceptable because of its lower local-complication rate and because it provides pressure-controlled cerebral perfusion.

Adult↗
PubMed2005

Cannulation of the axillary artery: the decision between direct cannulation and cannulation via side graft.

BACKGROUND: The axillary artery has emerged as promising alternative cannulation site when the ascending aorta is unsuitable for cannulation. However, in order to minimize vascular injury, the decision to cannulate the artery directly or via graft has to be considered carefully. METHODS: Seventy patients underwent axillary artery cannulation during a two-year period. Indications for operation were acute aortic dissection type A in 25(36 %), ascending aortic or arch aneurysm in 32 (46 %), redo surgery in 6 (9 %), and severely atherosclerotic aorta in 3 (4.3 %) patients. Depending on the diameter of the vessel and the rigidity of the wall, the artery was either cannulated directly or via an 8-mm prosthetic Dacron graft. RESULTS: Direct cannulation was performed in 46 patients (66 %) and cannulation via graft in the remaining 24 patients (34 %). The complication rate associated with axillary artery cannulation was 3.8 %. These two patients developed retrograde type A dissection and further dissection into the descending aorta caused by forceful insertion of a 20-French cannula in a very elastic and small artery. CONCLUSIONS: Cannulation of the axillary artery is an attractive approach with a wide indication spectrum. However, the decision to cannulate directly or via graft should be based on the diameter and elasticity of the vessel, to minimize the complications of vascular injury and subsequent dissection.

Adult↗
PubMed1990

Axillary artery compression and thrombosis in throwing athletes.

A 28-year-old major league baseball pitcher sustained an axillary artery thrombosis which was successfully treated with intraarterial urokinase. Subsequent angiography and duplex scanning with the arm elevated in the pitching position demonstrated inducible compression of the axillary artery by the humeral head as well as compression at the thoracic outlet. To determine the incidence of axillary and subclavian artery compression and to investigate the mechanism of injury, brachial artery blood pressures and duplex scans of the subclavian and axillary arteries were performed in both the neutral position and the throwing position in the 92 extremities of 19 major league baseball pitchers, 16 non-pitching major league players, and 11 nonathlete controls. A drop in blood pressure of greater than 20 mm Hg was noted in the position in 56% of extremities tested, with a loss of a detectable blood pressure in 13%. Compression of the axillary artery by the humeral head was documented in 83% of extremities, but in only 7.6% was a greater than 50% stenosis inducible. No statistical difference was found in the incidence of arterial compression between the three groups tested or between their dominant and nondominant extremities. Dissection of the axillary artery in two cadavers documented that abduction and external rotation of the arm causes compression of the axillary artery by the humeral head, which acts as a fulcrum. We conclude that the repetitive mechanical trauma of the throwing motion can cause intermittent compression and contusion of the axillary artery by the humeral head and predisposes the athlete who throws to thrombosis of the axillary artery.

Adult↗
PubMed2005

Axillary artery cannulation improves operative results for acute type a aortic dissection.

BACKGROUND: This study was undertaken to identify preoperative and postoperative predictors of hospital death of patients with acute type A aortic dissection. METHODS: Between May 1,1992, and July 31, 2004, 106 consecutive patients (59 male and 47 female, mean age 62.2 +/- 12.1 years) with acute type A aortic dissection underwent surgery with open technique and cerebral protection by antegrade selective cerebral perfusion. The external iliac artery or femoral artery alone was used for arterial cannulation in 37 patients; however, the right axillary artery was cannulated in 69 patients. Univariate analysis of potential risk factors was performed to identify risk factors for hospital death and was followed by multivariate analysis by a stepwise logistic regression model to identify independent risk factors. RESULTS: Sixteen patients died postoperatively, and the overall hospital mortality rate was 15.1%. Univariate analysis revealed shock (p = 0.020), visceral ischemia (p = 0.007), root replacement (p = 0.041), and absence of axillary artery perfusion (p = 0.003) as significant risk factors for hospital death. Multivariate analysis revealed visceral ischemia (p = 0.0028, odds ratio 18.4) and absence of axillary artery perfusion (p = 0.0014, odds ratio 8.2) as independent preoperative and intraoperative predictors of hospital death. CONCLUSIONS: Achievement of greater success in the surgical treatment of acute type A dissection will require axillary artery cannulation and measures to prevent visceral malperfusion.

Adult↗