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