HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Michael K. Banbury Delos M. Cosgrove, III Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Banbury, M. K. Articles by Cosgrove, D. M. Search for Related Content PubMed PubMed Citation Articles by Banbury, M. K. Articles by Cosgrove, D. M., III

Ann Thorac Surg 2000;69:957
© 2000 The Society of Thoracic Surgeons

---

How To Do It

Arterial cannulation of the innominate artery

^a Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

Address reprint requests to Dr Banbury, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195
e-mail: banburm{at}ccf.org

	Abstract

Top Abstract Introduction Technique Comment

 
Arterial cannulation of the innominate artery for cardiopulmonary bypass offers the advantage of central cannulation with standard cannulating techniques when the ascending and arch aorta are unavailable (eg, redo, aortic dissection, aneurysms). It avoids the difficulties associated with a second incision (axillary artery cannulation) and retrograde perfusion (femoral artery cannulation).

	Introduction

Top Abstract Introduction Technique Comment

 
Choosing the cannulation site for arterial return is an important point in the decision tree during the conduct of cardiopulmonary bypass. Success with cannulation of the axillary artery has prompted the use of the innominate artery for arterial return in some circumstances.

	Technique

Top Abstract Introduction Technique Comment

 
In the case of reoperation, it is often found that the ascending aorta is matted with Teflon felt pledges, sutures from old cannulation sites, or cardioplegia sites and grafts that are either occluded, diseased, or patent, but that commonly lay along the ascending aorta. This constellation can make arterial cannulation of the ascending aorta below the innominate artery quite difficult. In such a situation, it is often possible to dissect the innominate vein up off of the ascending aorta and innominate artery and thereby gain access to the underlying innominate artery. The vein can be reflected either cranially or caudally for access to the innominate artery. This site is usually untouched from prior surgery and provides a fresh dissection plane. The innominate artery is usually free of disease and is of sufficient caliber that it easily accommodates an arterial cannula.

In the case of ascending aortic aneurysms and ascending aortic dissection, the innominate artery is often spared from involvement. With ascending aneurysms, it is not unusual for the aneurysm to extend into the arch requiring hemiarch repair. In the case of aortic dissection, it is unwise to cannulate the arch, as it may or may not leave the tip of the cannula in the true lumen. However, the innominate artery is rarely involved directly with the dissection and, if so, this can be identified by direct visualization and palpation. Transesophageal echocardiography of the ascending, arch, and descending aorta during the commencement of cardiopulmonary bypass can help identify inadvertant cannulation of the false lumen in cases of aortic dissection. Cannulation of the innominate artery clears the field where the distal anastomosis of graft to aorta will be performed, thus facilitating that part of the procedure without the cannula obstructing the view. It is also easy to look into the arch during circulatory arrest after transection of the aorta and see the tip of the cannula in the innominate artery to confirm position. Simultaneous cannulation of the innominate artery and femoral vessels could help avoid lengthy circulatory arrest during aortic arch reconstruction.

Innominate artery cannulation eliminates the need for a second incision to gain access to other sites (eg, femoral artery, axillary artery). The innominate artery is invariably larger than the axillary artery, thus eliminating the frequent need to attach an 8-mm graft to the side of the vessel before cannulation. Though infrequent, brachial plexus injuries associated with axillary artery cannulation are avoided with the innominate artery.

Once the innominate artery is exposed, purse strings are placed on the anterior surface in the usual fashion. The purse strings are placed well below the bifurcation of the innominate artery. The innominate artery is then stabbed and the cannula introduced in the usual fashion with the tip pointing towards the aortic arch. The purse strings are snugged and the cannula is then affixed to the tourniquets. Typically, the 24 Sarns Soft Flow tip cannula (8.0-mm Soft-Flow Aortic Cannula, 65° angle) or the 21 Sarns flex cannula (7.0-mm Soft-Flow Extended Aortic Cannula; Sarns 3M Healthcare, Ann Arbor, MI), often used in minimally invasive surgery, is used for this procedure. The innominate artery is invariably of sufficient caliber to allow both antegrade and retrograde flow around the cannula tip. The remainder of the cannulation and conduct of cardiopulmonary bypass is performed in the standard fashion. After the completion of cardiopulmonary bypass, decannulation is performed by releasing the tourniquets, removing the cannula, and tying down the purse strings. This leaves a widely patent innominate artery. Distal pulsation can easily be palpated. Right radial or brachial arterial lines can be used to monitor the blood pressure during both cannulation and cardiopulmonary bypass as well as after decannulation to ensure that there is no obstruction to flow in the right subclavian artery and, by inference, the right carotid artery.

	Comment

Top Abstract Introduction Technique Comment

 
We have used this technique on more than 20 occasions when choosing the site for arterial cannulation has been problematic. There were no complications attributable to the cannulation site. The technique has been successfully employed in reoperations, ascending aortic aneurysms, and ascending aortic dissections. It is a safe addition to the expanding selection of potential cannulation sites.

Accepted for publication November 10, 1999.

This article has been cited by other articles:

				F. J. Huang, Q. Wu, C. W. Ren, Y. Q. Lai, S. Yang, Q. J. Rui, and S. D. Xu Cannulation of the Innominate Artery With a Side Graft in Arch Surgery Ann. Thorac. Surg., March 1, 2010; 89(3): 800 - 803. [Abstract] [Full Text] [PDF]

				A. N. Bhat and S. M. Bradley Innominate artery cannulation for congenital heart disease Interact CardioVasc Thorac Surg, February 1, 2010; 10(2): 331 - 333. [Abstract] [Full Text] [PDF]

				P Kaul, K Javangula, S Ganti, S Balaji, M Sivananthan, M Gough, and S Lindsay Continuous selective bilateral antegrade cerebral perfusion through anomalous innominate artery for repair of root, ascending aortic and arch aneurysm - challenges, vagaries and opportunities of bovine arch variant anatomy and review of literature Perfusion, March 1, 2009; 24(2): 121 - 133. [Abstract] [PDF]

				S. Ji, J. Yang, X. Ye, and X. Wang Brain Protection by Using Innominate Artery Cannulation During Aortic Arch Surgery Ann. Thorac. Surg., September 1, 2008; 86(3): 1030 - 1032. [Abstract] [Full Text] [PDF]

				J. W. Hammon Extracorporeal Circulation: Perfusion System Card. Surg. Adult, January 1, 2008; 3(2008): 350 - 370. [Full Text]

				K. Anastasiadis, P. Antonitsis, and C. Papakonstantinou Innominate artery cannulation MMCTS, January 1, 2008; 2008(1006): mmcts.2008.003418 - mmcts.2008.003418. [Abstract] [Full Text] [PDF]

				K.-M. Chiu, S.-J. Li, T.-Y. Lin, C.-Y. Chan, and S.-H. Chu Innominate Artery Cannulation for Aortic Surgery Asian Cardiovasc Thorac Ann, August 1, 2007; 15(4): 348 - 350. [Abstract] [Full Text] [PDF]

				P. Stassano, A. Musumeci, G. Iannelli, G. D'Alise, and M. Mottola A new cannula for innominate artery cannulation J. Thorac. Cardiovasc. Surg., September 1, 2005; 130(3): 944 - 945. [Full Text] [PDF]

				L. G. Svensson, E. H. Blackstone, J. Rajeswaran, J. F. Sabik III, B. W. Lytle, G. Gonzalez-Stawinski, P. Varvitsiotis, M. K. Banbury, P. M. McCarthy, G. B. Pettersson, et al. Does the Arterial Cannulation Site for Circulatory Arrest Influence Stroke Risk? Ann. Thorac. Surg., October 1, 2004; 78(4): 1274 - 1284. [Abstract] [Full Text] [PDF]

				D. S. Fusco, R. K. Shaw, M. Tranquilli, G. S. Kopf, and J. A. Elefteriades Femoral Cannulation is Safe for Type A Dissection Repair Ann. Thorac. Surg., October 1, 2004; 78(4): 1285 - 1289. [Abstract] [Full Text] [PDF]

				K. Watanabe, I. Fukuda, M. Osaka, and T. Imazuru Axillary artery and transapical aortic cannulation as an alternative to femoral artery cannulation Eur J Cardiothorac Surg, May 1, 2003; 23(5): 842 - 843. [Abstract] [Full Text] [PDF]

				E. A. Hessel II and L. H. Edmunds Jr. Extracorporeal Circulation: Perfusion Systems Card. Surg. Adult, January 1, 2003; 2(2003): 317 - 338. [Full Text]

				A. Mazzola, R. Gregorini, C. Villani, and M. Di Eusanio Antegrade cerebral perfusion by axillary artery and left carotid artery inflow at moderate hypothermia Eur J Cardiothorac Surg, May 1, 2002; 21(5): 930 - 931. [Abstract] [Full Text] [PDF]

				E. Prifti, M. Bonacchi, M. Leacche, and G. Frati Innominate artery cannulation in patients with severe porcelain aorta Ann. Thorac. Surg., January 1, 2001; 71(1): 399 - 400. [Full Text] [PDF]

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Michael K. Banbury Delos M. Cosgrove, III Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Banbury, M. K. Articles by Cosgrove, D. M. Search for Related Content PubMed PubMed Citation Articles by Banbury, M. K. Articles by Cosgrove, D. M., III