Right Axillary Artery Cannulation: Seldinger Technique

The authors present a right axillary artery cannulation in an elderly patient using the Seldinger technique. During axillary artery cannulation, the portion of the axillary artery between the first rib and the medial border of the pectoralis minor muscle is accessed. There are two ways to cannulate the axillary artery:

1. The direct approach: the artery is cannulated directly with the perfusion cannula inserted within a purse string (the Seldinger technique).
2. The indirect approach: the artery is approached indirectly by first sewing an 8 mm graft to the artery and then cannulating the graft.

Advantages of axillary artery cannulation:

• It allows perfusion of the brain during circulatory arrest.
• It avoids the complication of femoral artery cannulation.
• The axillary artery is rarely involved in atherosclerotic disease.

Cannulation Technique:

1. A 3-4 cm incision is made in the right infraclavicular region, parallel to the clavicles.
2. The pectoralis major muscle is divided in the direction of its fibers.
3. The clavipectoral fascia is incised.
4. The pectoralis minor muscle is exposed.
5. The pectoralis minor muscle is retracted laterally.
6. The fat tissue can be removed.
7. The brachial plexus branch is identified.
8. Heparin is administered.
9. In some patients, the thoracoacromial artery is isolated to avoid back bleeding.
10. The axillary artery is circled between vessel loops.
11. The purse string suture is performed using 4.0 Prolene, with two concentric, pledgeted, reinforced purse strings passed through a tourniquet.  
12. The puncture is made inside the purse string.
13. The guide wire is passed through the needle.
14. The guide wire is pulled back into the aorta under echocardiography guidance.
15. The needle is removed and the wire is used to guide subsequent dilators. The authors suggest that a cut be made in the adventitia to help introduce the cannula.
16. The axillary artery is cannulated (an Edwards Lifescience OPTI 20 French cannula is used in this video).
17. The guide wire is removed.
18. The tourniquet is fastened down.  
19. The cannula is tied to the tourniquet and sutured to the skin.