As I have gained more experience in minimally invasive surgery (2,000 cases), I have come to prefer the axillary artery as my second choice for cannulation. There is no doubt that the dissection is slightly more challenging. I perform the cannulation with a Seldinger technique as I do for the femoral artery. Keep in mind that femoral cannulation is my first access of choice. I feel that I have more control with the femoral and axillary artery. I leave central cannulation as a last option. I have analyzed my minimally invasive data relevant to the incidence of stroke with femoral cannulation and it is very similar to central cannulation. Keep in mind that I do NOT perform CT angiograms on any of my patients. I do consider myself a rebel when it comes to this concept, but who was the one who made this a definitive rule in minimally invasive surgery ? If I have a concern when I cannulate, I will perform an intraoperative angiogram through the canula.
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