Axillary versus femoral arterial cannulation in type A acute aortic dissection: evidence from a meta-analysis of comparative studies and adjusted risk estimates

Umberto Benedetto, Haider Mohamed, Piergiusto Vitulli, Mario Petrou

Research output: Contribution to journalArticle (Academic Journal)peer-review

26 Citations (Scopus)

Abstract

OBJECTIVES: There is a growing perception that femoral arterial cannulation (FAC), by reversing the flow in the thoracoabdominal aorta, may increase the risk of retrograde brain embolization, dissection and organ malperfusion in type A aortic dissection. Axillary artery cannulation (AXC) has been reported to improve operative outcomes by allowing antegrade blood flow. However, FAC still remains largely utilized as a consensus for the routine use of AXC has not yet been reached.

METHODS: A meta-analysis on comparative studies reporting operative outcomes using AXC versus FAC was performed. Pooled weighted incidence rates for end points of interest (both adjusted and unadjusted) have been computed using an inverse variance model.

RESULTS: Overall, a total of 8 studies including 793 patients were analysed (AXC = 396, FAC = 397). AXC was associated with reduced risk for in-hospital mortality [risk ratio (RR): 0.41; 95% confidence interval (CI): 0.29-0.58; P < 0.001] and permanent neurological deficit (PND) (RR: 0.59; 95% CI: 37.-0.93; P = 0.02) when compared with FAC. Pooled adjusted estimates confirmed that AXC was independently associated with a significantly reduced incidence of in-hospital mortality (adjusted OR: 0.54; 95% CI: 0.36-0.82; P = 0.004; I(2) = 57%) and PND (adjusted OR: 0.19; 95%CI: 0.07-0.54; P = 0.002; I(2) = 0%).

CONCLUSIONS: The present meta-analysis demonstrated that AXC is superior to FAC in reducing in-hospital mortality and the incidence of PND in patients operated on for type A acute aortic dissection.

Original languageEnglish
Pages (from-to)953-9
Number of pages7
JournalEuropean Journal of Cardio-Thoracic Surgery
Volume48
Issue number6
DOIs
Publication statusPublished - Dec 2015

Keywords

  • Aneurysm, Dissecting
  • Aortic Aneurysm
  • Axillary Artery
  • Brain Diseases
  • Catheterization, Peripheral
  • Femoral Artery
  • Humans
  • Risk Factors
  • Treatment Outcome
  • Comparative Study
  • Journal Article
  • Meta-Analysis

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