Miami Minimally Invasive Valves
Joseph Lamelas, MD
Dedicated to the Advancement of Minimally Invasive Cardiac Surgery
March 21, 2013
Axillary Cannulation, the next best option

This is my approach to axillary cannulation.  Once you watch the video you can convince yourself that you don’t need to add a side branch/graft to the axillary artery. I have used a Seldinger technique to cannulate the axillary artery but as you can see from the video, you do need to exert a little bit of pressure to pass the cannula. The axillary artery is more elastic and doesn’t allow passage of the cannula as freely as the femoral artery. With this in mind, as well as having to repair several arteries, I have been going to a more direct approach. This means that I obtain both proximal and distal control of the vessel, perform and arteriotomy, then directly cannulate the artery. I will pre-load a wire in the cannula so that once I introduce the cannula, I pass the wire into the artery, preferably with flouro guidance and thereafter, I will advance the cannula. I will almost always obtain an angio at this point. I have a few tricks to pass the wire if it becomes difficult to advance.  I will follow up with another blog post with this trick. Remember, keep your tool box full !!!!

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2 thoughts on “Axillary Cannulation, the next best option”

  1. Wagner, Bruce says:

    I understand you do an angio, is this to see placement of cannula in the aorta or to see distal flow into the right arm ? or both? Also do you put in a right radial A line prior to axillary cannulation? Last question, have you had any right arm complications from this in your vast experience?
    Thank you for these posts…very helpful.


    1. I usually will do an intra-operative angio to verify placement of the cannula and to reassure me that there isn’t plaque that may impede flow or cause a dissection. Keep in mind, when I need to do axillary cannulation it is because of severe peripheral vascular disease. It is not common to see significant disease in the axillary/subclavian artery. I do not assess distal flow in the arm. We usually place a left radial A-line in all of our patients. I have not seen any right arm complications yet with this approach.

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