İbrahim KARA, İlker MATARACI, Adil POLAT, Altuğ TUNCER, Cüneyt KELEŞ, Eylem Yayla TUNCER, Salih AULASALEH, Kamil BOYACIOĞLU

Is axillary arterial cannulation better than femoral arterial cannulation?

Amaç: Bu çalışmanın amacı, aort cerrahisinde kullanılan aksiller ve femoral arter kanülasyon stratejilerinin sonuçlarını karşılaştırmaktır. Çalışma planı: Çalışmaya alınan 192 hastanın 88’inde (%51.2) femoral arter kanülasyonu (grup F), 84’ünde (%48.8) ise aksiller arter kanülasyonu (grup A) kullanıldı. Tüm hastaların aort kökleri ve aortun en az bir segmentinin replasman veya onarım işlemleri uygulandı. Bulgular: Ortalama hipotermi derecesi, yoğun bakım ve hastane kalış süreleri grup A’daki hastalarda daha düşük bulundu. Mortalite oranı grup F’de %8 (n=7) ve grup A’da %3.6 (n=3) oldu (p=0.330). Grup F’de yedi hastada (%8), grup A’da ise 10 hastada (%11.9) cerrahi sonrasında nörolojik komplikasyon gözlemlendi. Ameliyat sonrası kanama, pulmoner komplikasyon ve enfeksiyon oranları grup F’de daha yüksekti. Lojistik regresyon analizinde geçirilmiş kardiyak cerrahi ve ameliyat sonrası nörolojik komplikasyon görülmesi ameliyat sonrası mortaliteyle ilişkili bulundu. Sonuç: Aksiller kanülasyon uygulamaları ameliyat süresinin kısalması ve daha az derinlikte hipotermi kullanılabilmesi açısından fayda sağlamaktadır. Hastaların yoğun bakım ve hastane kalış süreleri kısalmakta, ameliyat sonrası görülen kanama, enfeksiyon ve pulmoner komplikasyon oranı azalmaktadır.

Aksiller arter kanülasyonu femoral arter kanülasyonundan daha mı iyidir?

Background: This study aims to compare axillary and femoral arterial cannulation strategies in aortic surgery. Methods: Femoral artery cannulation (group F) was used in 88 (51.2%) and axillary artery cannulation (group A) was used in 84 (48.8%) of 192 patients. All patients had their aortic roots or one segment of their aortae replaced and/or repaired. Results: The mean degree of hypothermia, mean duration of intensive care and length of hospital stay were lower in group A patients. The mortality rate was 8% (n=7) in group F and 3.6% (n=3) in group A (p=0.330). Seven patients (8%) in group F and 10 patients (11.9%) in group A had neurologic complications following surgery. Postoperative incidences of bleeding, pulmonary complications and infections were higher in group F. Logistic regression analysis showed that previous cardiac surgery and postoperative neurologic complications were independently related to the postoperative mortality. Conclusion: Axillary artery cannulation is useful to decrease the operation time and use lesser degrees of hypothermia. Patients have less intensive care and hospital stays and also pulmonary and infectious complications and postoperative bleeding are reduced.

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1. Sabik JF, Lytle BW, McCarthy PM, Cosgrove DM. Axillary artery: an alternative site of arterial cannulation for patients with extensive aortic and peripheral vascular disease. J Thorac Cardiovasc Surg 1995;109:885-90.
2. Ergin MA, Galla JD, Lansman L, Quintana C, Bodian C, Griepp RB. Hypothermic circulatory arrest in operations on the thoracic aorta. Determinants of operative mortality and neurologic outcome. J Thorac Cardiovasc Surg 1994;107:788-97.
3. Edmunds LH Jr, Clark RE, Cohn LH, Grunkemeier GL, Miller DC, Weisel RD. Guidelines for reporting morbidity and mortality after cardiac valvular operations. The American Association for Thoracic Surgery, Ad Hoc Liaison Committee for Standardizing Definitions of Prosthetic Heart Valve Morbidity. Ann Thorac Surg 1996;62:932-5.
4. Hogue CW Jr, Palin CA, Arrowsmith JE. Cardiopulmonary bypass management and neurologic outcomes: an evidencebased appraisal of current practices. Anesth Analg 2006;103:21-37.
5. Kronzon I, Tunick PA. Aortic atherosclerotic disease and stroke. Circulation 2006;114:63-75.
6. Akgul A, Ozatik MA, Kucuker SA, Bahar I, Tasdemir O. Repair of the aortic arch with left unilateral selective cerebral perfusion. Perfusion 2004;19:77-9.
7. Dias RR, Silva IA, Fiorelli AI, Stolf NA. Cerebral protection: sites of arterial cannulation and brain perfusion routes. Rev Bras Cir Cardiovasc 2007;22:235-40.
8. Fusco DS, Shaw RK, Tranquilli M, Kopf GS, Elefteriades JA. Femoral cannulation is safe for type A dissection repair. Ann Thorac Surg 2004;78:1285-9.
9. Lakew F, Pasek P, Zacher M, Diegeler A, Urbanski PP. Femoral versus aortic cannulation for surgery of chronic ascending aortic aneurysm. Ann Thorac Surg 2005;80:84-8.
10. Svensson LG, Blackstone EH, Rajeswaran J, Sabik JF 3rd, Lytle BW, Gonzalez-Stawinski G, et al. Does the arterial cannulation site for circulatory arrest influence stroke risk? Ann Thorac Surg 2004;78:1274-84.
11. Moizumi Y, Motoyoshi N, Sakuma K, Yoshida S. Axillary artery cannulation improves operative results for acute type a aortic dissection. Ann Thorac Surg 2005;80:77-83.
12. Strauch JT, Spielvogel D, Lauten A, Lansman SL, McMurtry K, Bodian CA ,et al. Axillary artery cannulation: routine use in ascending aorta and aortic arch replacement. Ann Thorac Surg 2004;78:103-8.
13. Panos A, Murith N, Bednarkiewicz M, Khatchatourov G. Axillary cerebral perfusion for arch surgery in acute type A dissection under moderate hypothermia. Eur J Cardiothorac Surg 2006;29:1036-9.
14. Gulbins H, Pritisanac A, Ennker J. Axillary versus femoral cannulation for aortic surgery: enough evidence for a general recommendation? Ann Thorac Surg 2007;83:1219-24.