Selecting the arterial cannulation site in acute type A aortic dissection: axillary artery or femoral artery?

INTRODUCTION: The aim of this study was to investigate the effects of cannulation site (either the right axillary artery or the right/left main femoral artery) on the mortality and morbidity of postoperative acute type A aortic dissection (ATAAD) patients.
METHODS: A total of 41 ATAAD patients (male: female = 29: 12), of whom 15 underwent cannulations of the right axillary and 26 of the main femoral artery, were retrospectively evaluated. Post-operative mortality and morbidity were assessed and statistically analyzed.
RESULTS: Of the participants, 34 (82.9%) were type I and 7 (17.0%) were type II according to the DeBakey classification. Cerebral protection was achieved using deep hypothermia in 14 patients, and by antegrade cerebral perfusion in addition to deep hypothermia in 9 patients. Early postoperative mortality was 17.0% (n = 7). There were no significant differences between the axillary artery and femoral artery cannulation groups in terms of postoperative mortality and morbidity. However, a greater number of arcus aortic interventions was performed in the group undergoing axillary artery cannulation (Group II). In this group, the rate of antegrade cerebral perfusion was also high.
DISCUSSION AND CONCLUSION: Although the cannulation site in patients with ATAAD was not determined to affect mortality and morbidity, both options present advantages and disadvantages. We believe that all relevant factors pertaining to the patient as well as the surgical procedure to be employed should be evaluated in tandem in selecting the optimal cannulation site.