Axillary Artery:
Right Axillary artery has been used as a site for arterial inflow in as
many as 27% of cases in United States 15 and has been
favored by some surgeons who have reported excellent results27. The advantage lies in achieving antegrade flow
into the proximal arch, most often into the true lumen. Further, at the
time of arch repair, when circulatory arrest is commenced, by clamping
the proximal innominate artery it may act as the inflow for unilateral
antegrade cerebral perfusion. To gain access to the artery an incision
is made 2 finger breadths below the clavicle just medial to the
deltopectoral groove. Most use an 8 to 10 mm polyester graft sewed end
to side to the axillary artery. This graft is then connected to the
arterial limb of the cardiopulmonary bypass circuit.
However, one disadvantage lies in the additional time ( ̵̴ 15-30 minutes)
needed for dissecting and sewing a graft, more so in obese patients.
Furthermore, if the originating segments of subclavian or innominate
artery are dissected, use of this approach may lead to further
malperfusion or worsening of the arch disruption. In a hemodynamically
unstable patient, alternate access sites such as direct aortic or
femoral artery may be more desirable. 27