This is my approach to axillary cannulation. Once you watch the video you can convince yourself that you don’t need to add a side branch/graft to the axillary artery. I have used a Seldinger technique to cannulate the axillary artery but as you can see from the video, you do need to exert a little bit of pressure to pass the cannula. The axillary artery is more elastic and doesn’t allow passage of the cannula as freely as the femoral artery. With this in mind, as well as having to repair several arteries, I have been going to a more direct approach. This means that I obtain both proximal and distal control of the vessel, perform and arteriotomy, then directly cannulate the artery. I will pre-load a wire in the cannula so that once I introduce the cannula, I pass the wire into the artery, preferably with flouro guidance and thereafter, I will advance the cannula. I will almost always obtain an angio at this point. I have a few tricks to pass the wire if it becomes difficult to advance. I will follow up with another blog post with this trick. Remember, keep your tool box full !!!!
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