In the past, I had posted that I perform axillary cannulation with a Seldinger technique. I just want to clarify that I NO longer do this since I have had several axillary arteries that have been damaged. In one case using a Seldinger technique, the intima and artery were damaged to the point that it required an interposition Gortex graft. My routine now is to obtain proximal and distal control of the artery and perform a direct cutdown on the artery. I will then backload a wire into the arterial cannula, pass the tip of the cannula into the artery, then advance the wire. I will initially use TEE guidance to visualize the wire in the ascending aorta. It will preferentially go into the ascending aorta 95% of the time. If I have any difficulty accessing the location of the wire, I will use flouro to guide it. If I have difficulty passing the wire, I will remove everything and will try to regain access to the artery with a 6Fr sheath. I will then use a Wooly wire (I think it has a different name now?) ,which has a soft tip or glide wire (which is soft, floppy and slippery) and pass this through the sheath under flouro guidance. Once one of these wires go into the aorta, I will advance my sheath, remove this softer tip wire and exchange it for the original wire. Now I am ready to advance the cannula under flouro as well. I hope these steps are clear. I will try to make another movie to depict each of these maneuvers. I will always take and angiogram to access placement. The reason I do this is because I want to make sure that there is no contraindication to antegrade perfusion since most of the patients in which I perform axillary cannulation have severe PVD. Although, it is truly rare to see significant disease of the axillary, subclavian, innominate artery which cannot be cannulated. Of note, one can always perfuse with one cannula size smaller because since this is a form of central cannulation, the flows are usually better.
As you can also see in the enclosed pictures, this is a mini AVR with axillary cannulation. I rarely perform central cannulation anymore. I believe that I have more control and better exposure when the cannula is not in the field.