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Delos M Cosgrove - One of the best experts on this subject based on the ideXlab platform.
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Cannulation of the axillary artery with a side graft reduces morbidity
The Annals of Thoracic Surgery, 2004Co-Authors: Joseph F Sabik, Hassan Nemeh, Bruce W Lytle, Eugene H Blackstone, Jeevanantham Rajeswaran, Marc A Gillinov, Delos M CosgroveAbstract:BACKGROUND: The axillary artery is our preferred arterial Cannulation site when the ascending aorta cannot be cannulated. Previously, we cannulated the artery directly; now we use a side graft. The purposes of this study were to (1) investigate Cannulation-related morbidity and (2) determine whether use of a side graft reduces it. METHODS: From January 1993 to January 2001, 392 patients underwent 399 axillary artery Cannulations. Indications included calcified ascending aorta (129, 32%), ascending aortic aneurysm (115, 29%), type I aortic dissection (85, 21%), cardiac reoperation (70, 18%), and calcified femoral artery (26, 6%). The axillary artery was cannulated directly in 212 (53%) and with a side graft in 187 (47%). Comparisons of Cannulation-related morbidity between the direct Cannulation and side graft groups were made overall and after both adjusting and matching for propensity score. RESULTS: Cannulation-related morbidity was infrequent, with brachial plexus injury in 7 (1.8%), axillary artery damage in 7 (1.8%), aortic dissection in 3 (0.8%), and arm ischemia in 3 (0.8%). Only 4 of 187 (2.1%) occurred in the side graft group, versus 16 of 212 (7.0%) with direct Cannulation (p = 0.03). After propensity adjustment, the odds ratio for reduction of risk of Cannulation-related morbidity with use of a side graft was 0.15 (p = 0.002). CONCLUSIONS: Use of the axillary artery as inflow for cardiopulmonary bypass is associated with low morbidity. However, Cannulation with a side graft was associated with less Cannulation-related morbidity than direct Cannulation. Routine use of a side graft is recommended whenever axillary artery Cannulation is indicated.
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Cannulation of the axillary artery with a side graft reduces morbidity
The Annals of thoracic surgery, 2004Co-Authors: Joseph F Sabik, Hassan Nemeh, Bruce W Lytle, Eugene H Blackstone, Jeevanantham Rajeswaran, A. Marc Gillinov, Delos M CosgroveAbstract:The axillary artery is our preferred arterial Cannulation site when the ascending aorta cannot be cannulated. Previously, we cannulated the artery directly; now we use a side graft. The purposes of this study were to (1) investigate Cannulation-related morbidity and (2) determine whether use of a side graft reduces it. From January 1993 to January 2001, 392 patients underwent 399 axillary artery Cannulations. Indications included calcified ascending aorta (129, 32%), ascending aortic aneurysm (115, 29%), type I aortic dissection (85, 21%), cardiac reoperation (70, 18%), and calcified femoral artery (26, 6%). The axillary artery was cannulated directly in 212 (53%) and with a side graft in 187 (47%). Comparisons of Cannulation-related morbidity between the direct Cannulation and side graft groups were made overall and after both adjusting and matching for propensity score. Cannulation-related morbidity was infrequent, with brachial plexus injury in 7 (1.8%), axillary artery damage in 7 (1.8%), aortic dissection in 3 (0.8%), and arm ischemia in 3 (0.8%). Only 4 of 187 (2.1%) occurred in the side graft group, versus 16 of 212 (7.0%) with direct Cannulation (p = 0.03). After propensity adjustment, the odds ratio for reduction of risk of Cannulation-related morbidity with use of a side graft was 0.15 (p = 0.002). Use of the axillary artery as inflow for cardiopulmonary bypass is associated with low morbidity. However, Cannulation with a side graft was associated with less Cannulation-related morbidity than direct Cannulation. Routine use of a side graft is recommended whenever axillary artery Cannulation is indicated.
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Arterial Cannulation of the innominate artery.
The Annals of thoracic surgery, 2000Co-Authors: Michael K. Banbury, Delos M CosgroveAbstract:Arterial Cannulation of the innominate artery for cardiopulmonary bypass offers the advantage of central Cannulation with standard cannulating techniques when the ascending and arch aorta are unavailable (eg, redo, aortic dissection, aneurysms). It avoids the difficulties associated with a second incision (axillary artery Cannulation) and retrograde perfusion (femoral artery Cannulation).
John A. Elefteriades - One of the best experts on this subject based on the ideXlab platform.
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open seldinger guided femoral artery Cannulation technique for thoracic aortic surgery
The Annals of Thoracic Surgery, 2016Co-Authors: Athanasios Tsiouris, Sherif Elkinany, Bulat A Ziganshin, John A. ElefteriadesAbstract:Background Debate regarding the optimal Cannulation site for aortic surgery continues. We report our recent experience with a simple and rapid open Seldinger-guided technique for femoral Cannulation. Aside from speed and simplicity (no need for arterial incision or suture closure), this technique has the added benefit that the distal limb continues to be perfused, as no arterial snare is required. Methods We recently began routinely utilizing an open Seldinger-guided technique for femoral artery Cannulation. The artery is exposed surgically but cannulated by guidewire inside a pursestring without arterial incision. The pursestring is simply tied when deCannulation is performed. We report our experience with the routine application of this technique from August 2011 to April 2015. Results We reviewed the outcome of 337 consecutive peripheral arterial Cannulations performed for thoracic aortic surgery (303 femoral, 34 axillary) using the open Seldinger technique. Within the femoral Cannulation group, the hospital survival rate was 97% (295 of 303). The survival rate for elective operations was 98% (277 of 283), and 90% (18 of 20) for emergent/urgent. Seldinger-guided femoral Cannulation was performed for replacement of the ascending/aortic arch in 88% (266 of 303), the descending thoracic aorta in 7% (22 of 303), and the thoracoabdominal aorta in 5% (15 of 303). There were no instances of intraoperative malperfusion phenomena, arterial dissection, or vascular injury or rupture. No patients had postoperative acute limb ischemia. Local wound complications were observed in 1% of patients (3 of 303). The stroke rate was 1.6% (5 of 303). The same open Seldinger technique was also used without complication in the axillary Cannulation group. Conclusions An open Seldinger-guided femoral (or axillary) Cannulation technique is quick and easy to perform, with minimal vascular or other complications and extremely low risk of stroke. This technique is recommended for its speed, simplicity, and effectiveness, and for its preservation of distal arterial flow (which is occluded with the traditional arterial incision/arterial snare technique).
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Femoral Cannulation is Safe for Type A Dissection Repair
The Annals of thoracic surgery, 2004Co-Authors: Daniel S. Fusco, Richard K. Shaw, Maryann Tranquilli, Gary S. Kopf, John A. ElefteriadesAbstract:Abstract Background Recently, surgeons have embraced axillary artery Cannulation for type A aortic dissection repair out of concern for malperfusion phenomena with traditional femoral artery Cannulation. My colleagues and I sought to determine whether these concerns are justified. Methods Records of 86 consecutive patients (51 men and 35 women; age, 30 to 86 years; mean, 62 years) undergoing surgical repair for acute type A dissection were reviewed. Cannulation site, specific operative repair, and complications related to Cannulation were noted. Results Seventy-nine Cannulations were performed in the femoral artery (47 left, 23 right, and 9 unspecified), 3 in the axillary artery (1 left and 2 right), and 4 in the ascending aorta or arch. Deep hypothermic arrest was used in 64 operations. Seven involved re-sternotomy. Seventy patients had supracoronary grafts (2 with valve replacement and 10 with valve resuspension), and 16 underwent aortic root replacement. Fourteen patients were in shock from cardiac tamponade. Eighty patients survived the operation, and 71 were hospital survivors. Malperfusion on initiation of cardiopulmonary bypass was noted in 3 patients. In 1, the original Cannulation site was the ascending aorta, and the cannula was moved to the femoral artery for correction. In 2, the original Cannulation site was the femoral artery, and the cannula was moved to the ascending aorta. Malperfusion on clamping of the aorta or on resumption of aortic flow was noted in no patient. Postoperative ischemia of any vascular bed was noted locally only in 3 (cannulated) lower extremities. Conclusions Straight femoral Cannulation for all phases of type A dissection repair is appropriate and yields excellent clinical results. The anticipated malperfusion events are actually rare (2 of 79 with femoral artery Cannulation, or 2.5%).
Mehernoor F Watcha - One of the best experts on this subject based on the ideXlab platform.
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evaluation of ultrasound guided radial artery Cannulation in children
Pediatric Critical Care Medicine, 2009Co-Authors: Arjunan Ganesh, Robin D Kaye, Anne Marie Cahill, Whitney Stern, Reshma Pachikara, Paul R Gallagher, Mehernoor F WatchaAbstract:OBJECTIVE To compare ultrasound (US)-guided radial artery Cannulation with the traditional palpation technique. DESIGN : Prospective randomized study. SETTING Operating room in a tertiary care pediatric center. PATIENTS One hundred fifty-two children under 18 yrs of age requiring radial artery Cannulation. INTERVENTIONS Patients were randomized to either 1) palpation or 2) US guidance technique for radial artery Cannulation. MEASUREMENTS AND MAIN RESULTS The primary end point of the study was the time taken for attempted Cannulation by the first operator at the first site. Secondary end points included the number of attempts at arterial Cannulation, the number of cannulae used, and the need for additional assistance from another anesthesiologist. Eighty and 72 children were randomized to the palpation and the US-guided groups, respectively. There were no statistically significant differences in age, gender, weight, and systolic blood pressure between the two study groups. The designated first operator (20 pediatric subspecialty trainees and eight consultant anesthesiologists) had previous experience in US-guided arterial Cannulation in <10 cases, with 94% having experience in <5 cases. Although the radial artery was eventually cannulated in all patients, the designated operator was successful at the first site of Cannulation in only 66% and 69% in the palpation and US groups, respectively. There were no statistically significant differences between the groups in time to successful Cannulation, total number of attempts, number of successful Cannulations during the first attempt, or in the number of cannulae used for catheterization. CONCLUSIONS US guidance did not facilitate faster Cannulation of the radial artery in children in our study.
Eugene H Blackstone - One of the best experts on this subject based on the ideXlab platform.
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Cannulation strategies in acute type a dissection repair a systematic axillary artery approach
The Journal of Thoracic and Cardiovascular Surgery, 2019Co-Authors: Brad F Rosinski, Eugene H Blackstone, Jay J Idrees, Eric E Roselli, Emidio Germano, Selena R Pasadyn, Ashley M Lowry, Douglas R Johnston, Edward G Soltesz, Jose L NaviaAbstract:Abstract Objectives Consensus regarding initial Cannulation site for acute type A dissection repair is lacking. Objectives were to review our experience with systematic initial axillary artery Cannulation, characterize patients on the basis of Cannulation site, and assess outcomes. Methods From January 2000 to January 2017, 775 patients underwent emergency acute type A dissection repair. Initial axillary Cannulation was performed in 617 (80%), femoral in 93 (12%), and central in 65 (8.4%). In-hospital mortality and stroke risk factors were identified using logistic regression. Results Reasons for selecting initial central or femoral instead of axillary Cannulation included unsuitable axillary anatomy (n = 67; 42%), surgeon preference (n = 38; 24%), hemodynamic instability (n = 34; 22%), and preexisting Cannulation (n = 19; 12%). Cannulation site was shifted or added intraoperatively in 82 (11%), with initial Cannulation site being axillary (n = 23 of 617; 3.7%), central (6 of 65; 9.2%), or femoral (n = 53 of 93; 57%), for surgeon preference (n = 60; 73%), high flow resistance (n = 13; 16%), increased aortic false lumen flow (n = 6; 7.3%), and other (n = 3; 3.7%). In-hospital mortality was 8.6% (n = 67; lowest for axillary, 7.3% [P = .02]) and stroke 8.3% (n = 64). Hemodynamic instability (odds ratio [OR], 7.6; 95% confidence interval [CI], 4.2-14), limb ischemia (OR, 3.7; 95% CI, 1.5-9.3), stroke (OR, 5.5; 95% CI, 2.2-14), and aortic regurgitation (OR, 2.2; 95% CI, 1.2-4.2) at presentation were risk factors for mortality and central Cannulation site (OR, 2.3; 95% CI, 1.05-5.1) and aortic stenosis (OR, 2.4; 95% CI, 1.2-4.6) for stroke. Conclusions Systematic initial axillary Cannulation for acute type A dissection repair is safe and effective and can be tailored to patients' specific needs. With this strategy, comparable outcomes are observed among Cannulation sites and are largely determined according to patient presentation rather than Cannulation site.
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Cannulation of the axillary artery with a side graft reduces morbidity
The Annals of Thoracic Surgery, 2004Co-Authors: Joseph F Sabik, Hassan Nemeh, Bruce W Lytle, Eugene H Blackstone, Jeevanantham Rajeswaran, Marc A Gillinov, Delos M CosgroveAbstract:BACKGROUND: The axillary artery is our preferred arterial Cannulation site when the ascending aorta cannot be cannulated. Previously, we cannulated the artery directly; now we use a side graft. The purposes of this study were to (1) investigate Cannulation-related morbidity and (2) determine whether use of a side graft reduces it. METHODS: From January 1993 to January 2001, 392 patients underwent 399 axillary artery Cannulations. Indications included calcified ascending aorta (129, 32%), ascending aortic aneurysm (115, 29%), type I aortic dissection (85, 21%), cardiac reoperation (70, 18%), and calcified femoral artery (26, 6%). The axillary artery was cannulated directly in 212 (53%) and with a side graft in 187 (47%). Comparisons of Cannulation-related morbidity between the direct Cannulation and side graft groups were made overall and after both adjusting and matching for propensity score. RESULTS: Cannulation-related morbidity was infrequent, with brachial plexus injury in 7 (1.8%), axillary artery damage in 7 (1.8%), aortic dissection in 3 (0.8%), and arm ischemia in 3 (0.8%). Only 4 of 187 (2.1%) occurred in the side graft group, versus 16 of 212 (7.0%) with direct Cannulation (p = 0.03). After propensity adjustment, the odds ratio for reduction of risk of Cannulation-related morbidity with use of a side graft was 0.15 (p = 0.002). CONCLUSIONS: Use of the axillary artery as inflow for cardiopulmonary bypass is associated with low morbidity. However, Cannulation with a side graft was associated with less Cannulation-related morbidity than direct Cannulation. Routine use of a side graft is recommended whenever axillary artery Cannulation is indicated.
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Cannulation of the axillary artery with a side graft reduces morbidity
The Annals of thoracic surgery, 2004Co-Authors: Joseph F Sabik, Hassan Nemeh, Bruce W Lytle, Eugene H Blackstone, Jeevanantham Rajeswaran, A. Marc Gillinov, Delos M CosgroveAbstract:The axillary artery is our preferred arterial Cannulation site when the ascending aorta cannot be cannulated. Previously, we cannulated the artery directly; now we use a side graft. The purposes of this study were to (1) investigate Cannulation-related morbidity and (2) determine whether use of a side graft reduces it. From January 1993 to January 2001, 392 patients underwent 399 axillary artery Cannulations. Indications included calcified ascending aorta (129, 32%), ascending aortic aneurysm (115, 29%), type I aortic dissection (85, 21%), cardiac reoperation (70, 18%), and calcified femoral artery (26, 6%). The axillary artery was cannulated directly in 212 (53%) and with a side graft in 187 (47%). Comparisons of Cannulation-related morbidity between the direct Cannulation and side graft groups were made overall and after both adjusting and matching for propensity score. Cannulation-related morbidity was infrequent, with brachial plexus injury in 7 (1.8%), axillary artery damage in 7 (1.8%), aortic dissection in 3 (0.8%), and arm ischemia in 3 (0.8%). Only 4 of 187 (2.1%) occurred in the side graft group, versus 16 of 212 (7.0%) with direct Cannulation (p = 0.03). After propensity adjustment, the odds ratio for reduction of risk of Cannulation-related morbidity with use of a side graft was 0.15 (p = 0.002). Use of the axillary artery as inflow for cardiopulmonary bypass is associated with low morbidity. However, Cannulation with a side graft was associated with less Cannulation-related morbidity than direct Cannulation. Routine use of a side graft is recommended whenever axillary artery Cannulation is indicated.
Liangcheng Zhang - One of the best experts on this subject based on the ideXlab platform.
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modified long axis in plane ultrasound technique versus conventional palpation technique for radial arterial Cannulation a prospective randomized controlled trial
Medicine, 2020Co-Authors: Jiebo Wang, Zhongmeng Lai, Xianfeng Weng, Yong Lin, Qijian Huang, Jian Zeng, Junle Liu, Zisong Zhao, Ting Yan, Liangcheng ZhangAbstract:BACKGROUND A low first-pass success rate of radial artery Cannulation was obtained when using the conventional palpation technique (C-PT) or conventional ultrasound-guided techniques, we; therefore, evaluate the effect of a modified long-axis in-plane ultrasound technique (M-LAINUT) in guiding radial artery Cannulation in adults. METHODS We conducted a prospective, randomized and controlled clinical trial of 288 patients undergoing radial artery Cannulation. Patients were randomized 1:1 to M-LAINUT or C-PT group at Fujian Medical University Union Hospital between 2017 and 2018. Radial artery Cannulation was performed by 3 anesthesiologists with different experience. The outcome was the first and total radial artery Cannulation success rates, the number of attempts and the Cannulation time, and incidence of complications. RESULTS Two hundred eighty-five patients were statistically analyzed. The success rate of first attempt was 91.6% in the M-LAINUT group (n = 143) and 57.7% in the C-PT group (n = 142; P < .001) (odds ratio, 7.9; 95% confidence interval, 4.0-15.7). The total success rate (≤5 minutes and ≤3 attempts) in the M-LAINUT group was 97.9%, compared to 84.5% in the palpation group (P < .001) (odds ratio, 8.5; 95% confidence interval, 2.5-29.2). The total Cannulation time was shorter and the number of attempts was fewer in the M-LAINUT group than that in the C-PT group (P < .05). The incidence of hematoma in the C-PT group was 19.7%, which was significantly higher than the 2.8% in the M-LAINUT group (P < .001). CONCLUSIONS Modified long-axis in-plane ultrasound-guided radial artery Cannulation can increase the first and total radial artery Cannulation success rates, reduce the number of attempts, and shorten the total Cannulation time in adults.
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modified long axis in plane ultrasound technique versus conventional palpation technique for radial arterial Cannulation a prospective randomized controlled trial
medRxiv, 2019Co-Authors: Jiebo Wang, Zhongmeng Lai, Xianfeng Weng, Yong Lin, Qijian Huang, Jian Zeng, Junle Liu, Zisong Zhao, Ting Yan, Liangcheng ZhangAbstract:Background: A low first-pass success rate of radial artery Cannulation was obtained when using the conventional palpation technique(C-PT) or ultrasound-guided techniques, we therefore evaluate the effect of a modified long-axis in-plane ultrasound technique (M-LAINUT) in guiding radial artery Cannulation in adults. Methods：We conducted a prospective, randomized and controlled clinical trial of 288 patients undergoing radial artery Cannulation. Patients were randomized 1:1 to M-LAINUT or C-PT group at fujian medical university union hospital between 2017 and 2018. Radial artery Cannulation was performed by three anesthesiologists with different experience. The outcome was the first and total radial artery Cannulation success rates, the number of attempts and the Cannulation time. Results: 285 patients were statistically analyzed. The success rate of first attempt was 91.6% in the M-LAINUT group (n=143) and 57.7% in the C-PT group (n=142; P<0.001) (odds ratio, 7.9; 95% confidence interval, 4.0-15.7). The total success rate (≤5 min and ≤3 attempts) in the M-LAINUT group was 97.9%, compared to 84.5% in the palpation group (p <0.001) (odds ratio, 8.5; 95% confidence interval, 2.5-29.2). The total Cannulation time was shorter and the number of attempts was fewer in the M-LAINUT group than that in the C-PT group (p <0. 05). Conclusion: Modified long-axis in-plane ultrasound-guided radial artery Cannulation can increase the first and total radial artery Cannulation success rates, reduce the number of attempts and shorten the total Cannulation time in adults.