Cannulation Techniques and Alternative Approaches in Proximal Aortic Pathologies

This text outlines various cannulation techniques and alternative approaches utilized during surgical interventions for proximal aortic pathologies, particularly complex aortic dissections. Since these high-mortality conditions strictly require cardiopulmonary bypass to safely repair or replace the damaged aorta, establishing adequate arterial and venous flow through effective cannulation is paramount for patient survival. Axillary artery cannulation, typically performed on the right side using a graft anastomosis, offers major advantages, including preventing limb ischemia, avoiding direct arterial trauma, and facilitating rapid, straightforward decannulation. Conversely, femoral artery cannulation is utilized when pre-operative imaging shows the dissection flap has not reached the iliofemoral artery, using a secure purse-string suture; this can also be combined with a bypass graft to ensure contralateral limb perfusion if one side is obstructed. Femoral vein cannulation is highly favored for patients presenting with a very large ascending aorta or during complex redo surgeries. Lastly, brachiocephalic artery cannulation serves as an alternative approach, particularly during intensive aortic arch surgeries or when femoral cannulation fails to provide sufficient flow. Ultimately, meticulously understanding the specific nuances, benefits, and drawbacks of these diverse cannulation techniques is critical for minimizing devastating surgical complications.