As I have gained more experience in minimally invasive surgery  (2,000 cases),  I have come to prefer the axillary artery as my second choice for cannulation. There is no doubt that the dissection is slightly more challenging.  I perform the cannulation with a Seldinger technique as I do for the femoral artery.  Keep in mind that femoral cannulation is my first access of choice.  I feel that I have more control with the femoral and axillary artery.  I leave central cannulation as a last option. I have analyzed my minimally invasive data relevant to the incidence of stroke with femoral cannulation and it is very similar to central cannulation.  Keep in mind that I do NOT perform CT angiograms on any of my patients.  I do consider myself  a rebel when it comes to this concept, but who was the one who made this a definitive rule in minimally invasive surgery ?  If I have a concern when I cannulate, I will perform an intraoperative angiogram through the canula.

Axillary Cannulation (17Fr. Biomedicus)