Axillary Versus Femoral Cannulation for Aortic Surgery: Enough Evidence for a General Recommendation?

Gulbins, H; Pritisanac, A; Ennker, J.

doi:10.1016/j.athoracsur.2006.10.068

Cited by 97 publications

(87 citation statements)

References 46 publications

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“…On those clinical scenarios, it is believed that axillary artery had theoretical advantages over the femoral artery. However, there are no comparative controlled randomized trials [9]. Patients with important atherosclerosis of the ascending aorta frequently have concomitant atherosclerosis of the abdominal aorta [10], which increases the risk of embolization from femoral retrograde perfusion.…”

Section: Discussionmentioning

confidence: 99%

Artéria axilar na instalação de circulação extracorpórea: indicações e resultados

Atik

Faber²,

Corso³

et al. 2009

Rev Bras Cir Cardiovasc

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Objectives: To determine indications and results of axillary artery cannulation for cardiopulmonary bypass.Methods: From January 2005 through December 2008, axillary artery cannulation was used in 48 patients. Mean age was 62 ±11 years and 33 patients (69%) were males. Axillary artery was approached by infraclavicular incision and the cannula introduced in a 8 millimeter Dacron side graft.Results: Indications were calcified aorta (N=18, 38%), aortic dissection (N=15, 31%), ascending and/or aortic arch aneurysm (N=11, 23%) and prior to reoperative median sternotomy (N=4, 8%). Changes in intraoperative planning occurred most often in patients with calcified aorta (100% versus 10%, P<.0001) than in patients with other indications, which follow their preoperative plan. Cardiopulmonary bypass (deep hypothermic circulatory arrest in 55% and conventional in the remaining) was uneventfully conducted in all patients but one (success rate 98%) due to undiagnosed inominate artery stenosis. Local complication was lymphatic drainage in three patients (6.2%). Bras Cir Cardiovasc 2009; 24(3): 404-408 Conclusions Rev

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Section: Discussionmentioning

confidence: 99%

Artéria axilar na instalação de circulação extracorpórea: indicações e resultados

Atik

Faber²,

Corso³

et al. 2009

Rev Bras Cir Cardiovasc

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“…(3,4) Asendan aort anevrizma operasyonlarında tartışılan teknik yöntemler-de esas olarak üç faktör rol oynamaktadır: 1-Sıcaklık: Operasyonun derin hipotermik sirkülatuar arrest (DHSA) yöntemi uygulanarak ya da orta şiddette hipotermik sirkülatuar arrest (OHSA) yöntemi ile yapılması tartışılmaktadır. (3)(4)(5) 2-Serebral perfüzyon tekniği: Antegrad serebral perfüzyon ile retrograd serebral perfüzyon tekniklerinin karşılaştırılması yapılmakta-dır. (4)(5)(6) 3-Operasyon sırasında uygulanan kanülasyon tekniğinin önemi ve sağkalım üzerindeki rolü araştırılmaktadır.…”

Section: Introductionunclassified

“…(3)(4)(5) 2-Serebral perfüzyon tekniği: Antegrad serebral perfüzyon ile retrograd serebral perfüzyon tekniklerinin karşılaştırılması yapılmakta-dır. (4)(5)(6) 3-Operasyon sırasında uygulanan kanülasyon tekniğinin önemi ve sağkalım üzerindeki rolü araştırılmaktadır. Yakın zamanda aksiller ve femoral kanülasyon tekniklerini karşılaştıran çalışmalar yayın-lanmış ve aksiller kanülasyon uygulanan acil Tip A aort diseksiyon olgularında sağ karotis arterden antegrad akımın sağlan-ması yolu ile serebral perfüzyon uygulanmasının hastalardaki nörolojik sekelleri azalttığı gösterilmiştir.…”

Section: Introductionunclassified

The Effects of Different Methods Applied for the Protection of Myocardial and Brain Functions During Aortic Aneurysm Repair Surgery on the Prognosis and Survival

Baysal¹,

Doğukan²,

Temel³

et al. 2012

JTAICS

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ÖZETAmaç: Aort anevrizma onarım operasyonlarında farklı cerrahi kanülasyon teknikleri, ısı regülasyonu ve beyin koruma yöntemlerinin mortalite üzerinde etkili perioperatif risk faktörleri ile ilişkisinin incelenmesini amaçladık. Bu nedenle; derin hipotermik sirkulatuar arrest (DHSA) ve retrograd serebral perfüzyon (RSP) altında femoral veya aortik kanülasyon ile uygulanan hastalar, orta derecede hipotermik sirkulatuar arrest (OHSA) ve selektif antegrad serebral perfüzyon (SASP) altında aksiller kanülasyon uygulanan hastalar karşılaştırıldı.Gereç ve Yöntem: Aortik ark anevrizma onarım operasyonu olan 110 ardışık hasta prospektif nonrandomize bir çalışma planı içeri-sinde üç ayrı gruba cerrahi patoloji, operasyon ve anestezi tekniklerine dayanılarak ayrıldı. Grup 1'de; femoral kanülasyon, DHSA (22-25°C), ve RSP uygulanırken, Grup 2'de; aksiller kanülasyon, OHSA ve SASP, Grup 3'te; aortik kanülasyon, DHSA ve RSP uygulandı. Perioperatif risk faktörleri araştırıldı.Bulgular: Üç grup karşılaştırıldığında kros klamp ve kardiyopulmoner baypas (KPB) süreleri (dk.) farklı idi (Grup 1'de; 75,62±26,28 ve144,15±66,71, Grup 2'de; 60,57±26,32 ve 109,09±45,38, Grup 3'te; 72,90±23,33 ve 120,83±53,46 sırası ile p=0,021). Mortalite hızlarının karşılaştırması; Grup 1'de 10/34 (% 29,4), Grup 2'de 3/47 (% 6,4) ve Grup 3'te 3/29 (% 10,3) (p=0,011) hasta olduğunu gösterdi. IABP kullanımı, kalp yetmezliği, atrial ritim bozukluklarının mortalite için bağımsız risk faktörleri olduğu saptandı (% 95 gü-ven aralığında; Hosmer and Lemeshow testi, ki kare=5,71 ve p=0,68).Sonuç: OHSA, SASP ve aksiller kanülasyon ile aortik ark anevrizma onarımı geçiren hastalarda morbidite ve mortalite DHSA, RSP ve femoral veya aortik kanülasyon yapılan hastalar ile karşılaştırıldığında daha az oranda gözlenmektedir.Anahtar kelimeler: Aortik anevrizma, derin hipotermik sirkülatuar arrest, orta derecede hipotermik sirkulatuar arrest SUMMARY The Effects of Different Methods Applied for the Protection of Myocardial and Brain Functions During Aortic Aneurysm Repair Surgery on the Prognosis and SurvivalObjective: Our aim was to investigate the relation between perioperative risk factors influencing mortality and different methods of surgical cannulation, temperature regulation and cerebral protection in patients undergoing aortic aneurysm repair surgery. For this purpose; patients requiring deep hypothermic circulatory arrest (DHCA), retrograde cerebral perfusion (RCP) and femoral or aortic cannulation were compared with patients requiring axillary cannulation, moderate hypothermic circulatory arrest (MHCA) and selective antegrade cerebral perfusion (SACP).Material and Methods: 110 consecutive patients undergoing aortic arch aneurysm repair surgery were divided into three groups in a prospective, nonrandomized study plan depending on surgical pathology, operation and anesthesia techniques. In Group 1, femoral cannulation, DHCA (22-25°C) and RSP ; in Group 2, axillary cannulation, MHCA (26-28°C) and SACP, whereas, in Group 3, aortic cannulation, DHCA and RCP were per...

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“…In any case, there is no clear evidence of the superiority of the axillary artery to the femoral artery, and the choice will depend on the clinical circumstances of the patient and the surgeon's preferences (9,10).…”

Section: Hypothermiamentioning

confidence: 99%

Intraoperative care for aortic surgery using circulatory arrest

et al. 2017

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Abstract:The total circulatory arrest (CA) is necessary to achieve optimal surgical conditions in certain aortic pathologies, especially in those affecting the ascending aorta and aortic arch. During this procedure it is necessary to protect all the organs of ischemia, especially those of the central nervous system and for this purpose several strategies have been developed. The first and most important protective method is systemic hypothermia. The degree of hypothermia and the route of application have been evolving and currently tend to use moderate hypothermia (MH) (20.1-28 ℃) associated with unilateral or bilateral selective cerebral perfusion methods. In this way the neurological results are better, the interval of security is greater and the times of extracorporeal circulation are smaller. Even so, it is necessary to take into account that there is the possibility of ischemia in the lower part of the body, especially of the abdominal viscera and the spinal cord, therefore the time of circulatory stop should be limited and not to exceed 80 minutes. Evidence of possible neurological drug protection is very weak and only mannitol, magnesium, and statins can produce some benefit. Inhalational anesthetics and some intravenous seem to have advantages, but more studies would be needed to test their long-term benefit. Other important parameters to be monitored during these procedures are blood glucose, anemia and coagulation disorders and acid-base balance. The recommended monitoring is common in complex cardiovascular procedures and it is of special importance the neurological monitoring that can be performed with several techniques, although currently the most used are Bispectral Index (BIS) and Near-Infrared Spectroscopy (NIRS). It is also essential to monitor the temperature routinely at the nasopharyngeal and bladder level and it is important to control coagulation with rotational thromboelastometry (ROTEM).

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Axillary Versus Femoral Cannulation for Aortic Surgery: Enough Evidence for a General Recommendation?

Cited by 97 publications

References 46 publications

Artéria axilar na instalação de circulação extracorpórea: indicações e resultados

Artéria axilar na instalação de circulação extracorpórea: indicações e resultados

The Effects of Different Methods Applied for the Protection of Myocardial and Brain Functions During Aortic Aneurysm Repair Surgery on the Prognosis and Survival

Intraoperative care for aortic surgery using circulatory arrest

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