Femoral Artery:
Historically, femoral cannulation has been the most commonly used
approach, and even in contemporary series it is utilized in almost 1/3
of all repairs 15, 24 . The femoral artery can be
accessed either by direct cannulation (percutaneous using modified
Seldinger technique, or after an open cut down), or by connection to an
8 mm or 10 mm polyester graft sewed to the native vessel in an
end-to-side configuration.
The use of femoral artery as site for arterial inflow is best when the
following pre-requisites are met: a) the vessel is not dissected; b) the
femoral artery originates from the true lumen of the dissected aorta,
ideally with patent true lumen at the aortic bifurcation; and c) absent
or minimal atherosclerotic disease. On rare occasions, especially in
patients who are hemodynamically unstable, femoral artery cannulation is
attempted even when it appears to be dissected; in such a situation one
should endeavor to place the cannula into the true lumen using modified
Seldinger technique.
Retrograde blood flow established by this approach can lead to possible
detrimental effects such as cerebral embolization, central organs
malperfusion 25, 26, and might even worsen proximal
flow 27. Evidence of any malperfusion when initiating
cardiopulmonary bypass should lead to rapid weaning off bypass followed
by search for alternate cannulation sites. Due to the retrograde nature,
the flow into false lumen may lead to further false lumen expansion and
extension of the dissecting intimal flap 28.