Direct versus side graft cannulation from the right axillary artery in thoracic aortic surgery.

Abstract Background the axillary artery can be cannulated for antegrade cerebral perfusion directly or by employing a prosthetic vascular graft anastomosed to the artery. Methods From 2008 until 2019, 688 patients underwent axillary artery cannulation. Of those, 287 underwent direct cannulation and 401 cannulation through a side graft. We identified risk factors for cannulation-related complications, and after propensity score matching, we compared the two matched cohorts’ cannulation-related and postoperative outcomes. Results A smaller axillary-artery diameter (odds ratio, 0.70; 95% confidence interval, 0.56-0.87) and emergency surgery (odds ratio, 2.23; 95% confidence interval, 1.27-3.92) were identified as risk factors for cannulation-associated complications. In the propensity-score matched cohorts (n = 266 in each), the number of patients suffering cannulation-related complications was significantly higher in the direct cannulation group than in the side graft group (n=33 [12.4%] vs n=15 [5.6%], p=0.01). The direct group’s incidence of iatrogenic axillary artery dissection was significantly higher (n=17 [6.4%] vs n=4 [1.5%], p=0.008); their incidence of postoperative stroke was also significantly higher (n=39 [14.7%] vs n=21 [7.9%], p=0.025). Patients cannulated with a side graft needed more (3.0 [1.0, 6.0] vs 4.0 [2.0, 7.0] p = 0.009) transfusions of blood products. Conclusions Cannulating the right axillary through a vascular prosthetic graft reduces cannulation-related complications such as iatrogenic axillary artery dissection, and lowers stroke rates. To help prevent cannulation-related complications and stroke, we recommend the routine use of a side graft when cannulating the axillary artery.