Document Detail

Arterial inflow via an axillary artery graft for the severely atheromatous aorta.
MedLine Citation:
PMID:  9692435     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Strategy for severe aortic atheromatous disease identified by intraoperative epiaortic ultrasound remains to be determined. We used axillary artery inflow through graft interposition in an attempt to avoid potential embolization. METHODS: Between July 1995 and June 1997, axillary artery inflow was used in 29 patients. Procedures performed were coronary artery bypass in 21 patients (3 with combined carotid endarterectomy), aortic valve replacement in 2, valve replacement plus coronary artery bypass in 4, atrial septal defect repair in 1, and arch replacement in 1 patient. Fibrillatory arrest was used in 16 patients and circulatory arrest was used in 16 patients for excision of mobile atheroma or arch reconstruction. Antegrade cerebral perfusion through the axillary artery graft was carried out in 11 patients. RESULTS: There were no brachial neurovascular complications. Two operative deaths occurred. Two patients had operative strokes and 2 more had postoperative stroke, all with resolution at late follow-up. There were no strokes in the subset of patients who had antegrade cerebral perfusion during circulatory arrest. CONCLUSION: The axillary artery is an excellent site for arterial inflow. Furthermore, antegrade cerebral perfusion is easily accomplished during periods of circulatory arrest. Finally, graft placement avoids potential local neurovascular complications.
Y R Baribeau; B M Westbrook; D C Charlesworth; C T Maloney
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  66     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  1998 Jul 
Date Detail:
Created Date:  1998-08-14     Completed Date:  1998-08-14     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  33-7     Citation Subset:  AIM; IM    
New England Heart Institute, Catholic Medical Center, Manchester, New Hampshire, USA.
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MeSH Terms
Aged, 80 and over
Aorta, Thoracic / surgery
Aortic Diseases / surgery*,  ultrasonography
Aortic Valve / surgery
Arteriosclerosis / surgery*,  ultrasonography
Axillary Artery / physiology*
Catheterization / instrumentation,  methods
Cerebrovascular Circulation
Cerebrovascular Disorders / etiology
Coronary Artery Bypass / adverse effects
Endarterectomy, Carotid / adverse effects
Extracorporeal Circulation / instrumentation,  methods*
Heart Arrest, Induced
Heart Septal Defects, Atrial / surgery
Heart Valve Prosthesis Implantation / adverse effects
Intracranial Embolism and Thrombosis / prevention & control
Intraoperative Care
Intraoperative Complications
Middle Aged
Postoperative Complications
Survival Rate
Ultrasonography, Interventional
Comment In:
Ann Thorac Surg. 2000 Jan;69(1):317   [PMID:  10654555 ]

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