I have enclosed a you tube video link to my technique for femoral cannulation.
If femoral cannulation is not possible, my second choice would be axillary.
I am constantly asked if a CT angio is absolutely required to perform these cases. The answer is NO,NO,and NO.
I know there will be those that will consider this crazy, not “by the book”, or even unethical. I am not saying that it should not be performed, but I have not found it necessary in over 2,000 cases!!! If I suspect severe PVD, then I might consider it. Where has it been “written is stone” that it must be performed before any minimally invasive case? If one utilizes an endo-balloon or performs a TAVR via a femoral platform, then it is necessary. The main reason is because a device is being passed and scraped along the vessel walls and can dislodge mobile plaque. Although, despite even when there is plaque within the aorta, these devices are used.
My question to those that question why not do a CT angio on everyone would be, 1.what will you do with the findings? 2. how do you interpret the findings to guide your operative strategy? 3. How do you really know that the findings are really dangerous and contraindicate cannulation?
I have performed over 2000 cases with this approach and my incidence of stroke is less than 1.5% for all risk groups. I truly believe that the stroke risk is not related to the cannulation technique, but more so to inadequate de-airing or particulate matter in the heart or from aortic cross clamping. We will be publishing our results soon.