Arterial inflow via an axillary artery graft for the severely atheromatous aorta - Discussion

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. Conclusions. 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.