Combined Axillary-Femoral Artery Cannulation Versus Conventional Femoral Artery Single Cannulation: Cerebral Protection Benefits in Stanford Type A Aortic Dissection Repair Surgery

Abstract

AIM: Conventional femoral artery cannulation with retrograde perfusion may increase the incidence of cerebral embolism in treating Stanford type A aortic dissection (STAAD). This study aimed to compare the neuroprotective effect of combined axillary-femoral artery cannulation utilizing an antegrade-retrograde perfusion strategy with femoral artery single cannulation in STAAD surgery. METHODS: This was a two-center, retrospective cohort study including 120 patients who underwent STAAD surgery between January 2021 and January 2025. Among them, 63 patients received combined axillary-femoral artery cannulation (double arterial cannulation group, DAC group), while 57 patients underwent conventional femoral artery single cannulation (single arterial cannulation group, SAC group). Perioperative parameters, neurological outcomes, including incidences of permanent/transient neurological dysfunction (PND/TND), delirium and coma duration, modified Rankin Scale (mRS) score, and Montreal Cognitive Assessment (MoCA) score, were evaluated. Serum biomarkers of brain injury, including neuron-specific enolase (NSE) and S100 calcium-binding protein B (S100B) protein levels, as well as postoperative general complications, were also analyzed. RESULTS: There was no significant difference in the key perioperative time parameters between the two groups (p > 0.05). Regarding neuroprotection, the DAC group exhibited superior outcomes, with significantly lower incidences of PND and TND, and shorter coma and delirium durations (p < 0.05). The DAC group also achieved better mRS and MoCA scores at 30 and 90 days postoperatively (p < 0.001). Peak postoperative levels of NSE and S100B were significantly lower in the DAC group (p < 0.001). Multivariate linear regression analyses revealed that the DAC strategy was an independent protective factor associated with improved neurological function (mRS), enhanced cognitive performance (MoCA), lower brain injury biomarker levels (NSE and S100B), and reduced coma and delirium durations (p < 0.001). There was no significant difference in the overall incidence of postoperative general complications between the two groups (p > 0.05). However, the incidence of postoperative limb ischemia was significantly lower in the DAC group (p < 0.05). CONCLUSIONS: Compared with conventional femoral artery single cannulation, combined axillary-femoral artery cannulation provides superior and independent cerebral protection during STAAD surgery. This approach reduces permanent and transient neurological deficits, mitigates early brain injury, enhances neurological and cognitive recovery, and lowers the incidence of postoperative limb ischemia. It holds promise as a safe and effective cerebral protective perfusion strategy in STAAD surgical management.

Affiliated Institutions

• Xuzhou Medical College CN
• Second People’s Hospital of Huai’an CN

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