Arterial Site Research Articles

Upregulation of sodium-glucose cotransporter 2 (SGLT2) expression in cultured senescent endothelial cells and in arterial sites at risk in vivo in rats

Endothelial senescence is thought to promote endothelial dysfunction and the subsequent development of cardiovascular diseases. The EMPA-REG trial has shown that sodium-glucose cotransporter 2 (SGLT2) inhibition is associated with a reduced risk of cardiovascular mortality in type 2 diabetic patients, but the protective mechanism remains unclear. SGLT2 mRNA has not been detected in control endothelial cells (ECs). This study examined the possibility that SGLT2 contributes to endothelial senescence and dysfunction and, if so, to characterize the underlying mechanism. Endothelial cells isolated from porcine coronary arteries were used at passage 1. Senescence was assessed using senescence-associated beta-galactosidase activity (SA-beta-gal activity), protein level by Western blot analysis, oxidative stress using dihydroethidium, and NO formation by electronic paramagnetic resonance. Exposure of ECs to HG (25 mM) for 96 h increased the level of SA-beta-gal activity and of senescence markers (p21 and p16) and oxidative stress, decreased eNOS expression and NO formation, and increased the expression of VCAM-1 and tissue factor (TF). Both HG and H 2 O 2 induced the appearance of SGLT2 mRNA, increased SGLT2 protein level and SGLT2-mediated glucose entry in ECs. An increased expression level of SGLT2 and VCAM-1, and a down-regulation of eNOS were observed at arterial sites at risk (aortic cross) compared with those at low risk (thoracic aorta) in young rats. These findings indicate that premature ECs ageing is characterized by the down-regulation of NO formation and the expression of pro-atherothrombotic factors, and is associated with the redox-sensitive upregulation of SGLT2 expression promoting excessive glucose entry. The fact that an increased SGLT2 expression level is observed in vivo at arterial sites at risk, suggests that inhibition of SGLT2 might be an attractive strategy to protect the cardiovascular system.

Femoral artery versus right axillary artery cannulation in various cardiac procedures, a single center experience: The quest for the holy grail

BackgroundThere are many arterial cannulation sites to establish cardiopulmonary bypass (CPB). Each site has its advantages and disadvantages. Organ malperfusion especially the cerebral malperfusion during CPB is the most critical outcome in comparing different arterial sites. We aimed to evaluate safety and efficacy of axillary and femoral arterial cannulation in various situations. MethodsThis retrospective observational study, included 75 patients underwent redo valve surgery or denovo thoracic aorta surgery. Patients were reviewed in terms of organ malperfusion namely brain and kidney; and cannulation site related complications. Patients were divided into two groups Femoral group (n = 46) and Axillary group (n = 29). ResultsThe mortality in the femoral group was 4.35%, while the axillary group showed a 3.45% mortality; without statistically significant difference. The axillary group had a significantly lower total hospital stay (p value 0.002), and highly significant lower ventilation hours (p value < 0.001). Other post-operative complications were lower in the axillary groups, without reaching statistical significance. ConclusionsBoth axillary and femoral artery cannulation provide a safe quick route for establishing CBP support in critical conditions before opening the chest. The axillary route is more technically demanding while the femoral route is handier in such cases. Individual arterial cannulation strategy should be done for each patient with a backup plan.

Contrast-induced acute kidney injury in a planned endovascular interventions on the&#x0D; coronary arteries.

Was performed a retrospective analysis of the frequency of contrast-induced acute kidney injury (CI-AKI) after the elective endovascular interventions on the coronary arteries in patients with stable coronary heart disease (CAD). CI-AKI was found in 23 patients (15,5%). Patients with CI-AKI initially significantly more likely to suffer chronic kidney disease (CKD), had higher erythrocyte sedimentation rate (ESR) before coronary intervention, received a significantly larger dose of the contrast medium, determines the ratio of the volume of the entered contrast medium to the glomerular filtration rate (VC/GFR). Predictors of CI-AKI, associated with the characteristics of patients are history of CKD (OR = 9,2; 95% CI 2,89-29,25; p &lt;0,001) and COPD (OR = 4,07; 95% CI 1,23-13,5; p = 0,015), increased ESR before PCI ≥11,5 mm/h (AUC = 0,677; 95% CI 0,539-0,815; p = 0,025). Predictors of CI-AKI, associated with the conduct of the PCI procedure, are the ratio VC/GFR≥3,25 (AUC=0,633; 95% CI 0,505-0,762; р=0,042) and complications of arterial puncture site (OR = 1,23; 95% CI 1,13-1,33, p = 0,025). According to the analysis of Kaplan-Meier probability of overall survival and survival without fatal cardiovascular events in 7 years after the index PCI was significantly higher in the group of patients without CI-AKI.

Abstract No. 437 How much do fibers on embolic coils improve embolization efficiency?

Pushable embolic coils are manufactured in numerous styles and configurations. Fibered embolic coils remain the traditional mainstay in coil design. Yet, the impact of these fibers on embolization coils and how these fibers improve embolization are not well validated or studied. We aim to test the impact of these fibers utilizing the same detachable coil, with and without fibers using an animal swine model. Standard commercially available 0.035’ fibered coils were used; we specially acquired the same coils with the fibers removed. Occlusion efficiency was assessed by the number of coils used, unit length of coils, and the amount of time required for complete embolization. A total of 2 swine were used via a transfemoral approach. A total of 12 artery sites were embolized; matched 6 paired and similarly sized arteries (subclavian, inferior renal and internal femoral arteries). Each was subselected and embolized utilizing the same embolization protocol via a 5F JB1 catheter. Embolization was performed with detachable fibered coil on one side, and identical yet unfibered coil on the contralateral vessel. Standard clinical embolization practice and flow scoring (TIMI grading) was employed throughout. Average vessel size was similar for the fibered side (mean, 4.46 mm; range, 3.49-6.93 mm) vs non-fibered (mean, 4.74 mm; range, 3.33-66.9 mm). Average occlusion time was lowest for fibered coils with a mean time 7.16 min. vs 17.16 min in unfibered coils. Unit length coil used to achieve complete embolization was significantly less in fibered coil with a mean length of 28.3 cm (total, 170 cm) vs the unfibered which had a mean length of 60 cm (total, 360 cm). Fibered coils have a substantially improved embolization efficiency over those without fiber in the same coil design as measured by embolization time, number of coils used, and unit length of coil used in an animal model. These fibers directly reduce embolization time and number of coils required for complete embolization, which may translate into a reduction in procedure times and costs.

Do Nonalcoholic Fatty Liver Disease and Fetuin-A Play Different Roles in Symptomatic Coronary Artery Disease and Peripheral Arterial Disease?

Background and Aims: Nonalcoholic fatty liver disease (NAFLD) is strongly associated with both atherosclerotic cardiovascular disease (CVD) and Fetuin-A. However, the association of Fetuin-A with atherosclerosis is more controversial. We hypothesized that the pathogenic interplay of NAFLD, Fetuin-A and atherosclerosis varies based on arterial site. Accordingly, we aimed to assess NAFLD prevalence, Fetuin-A values and their relationship with symptomatic atherosclerosis occurring in different localizations: coronary artery disease (CAD) vs. peripheral arterial disease (PAD). Methods: One hundred and forty-nine consecutive patients with symptomatic atherosclerotic CVD were recruited: 45 with CAD diagnosed by coronary angiography and 104 with PAD detected by doppler-ultrasound and/or computed tomography angiography and/or angiography. NAFLD was diagnosed based on both ultrasonography and exclusion of competing etiologies. Serum Fetuin-A was measured with ELISA. Results: NAFLD was detected in 54% of the overall group, with higher rates in PAD (59%) than CAD (42%) patients. Median Fetuin-A values were 256 (111–662) μg/mL, higher in patients with CAD (378 (124−662) μg/mL) than those with PAD (236 (111−461) μg/mL). The main findings were: (1) CAD patients had higher Fetuin-A values and less frequently NAFLD than PAD patients; (2) NAFLD was positively associated with Fetuin-A values; however, this association was limited to CAD patients only; (3) Fetuin-A values were positively associated with both CAD and NAFLD. Conclusion: The pathogenic interplay of NAFLD, Fetuin-A and atherosclerosis probably varies according to the arterial site.

Genetics of Intracranial Aneurysms.

Intracranial aneurysms (IAs) are localized dilatations of intracranial arteries that are because of weaknesses of the endothelial layer. These dilations vary in size (small aneurysms, 25 mm) and are classified according to their shapes: either localized sac-like pouches or long dilatations that increase the vessels diameter; these shapes are referred to, respectively, as saccular or berry aneurysms and fusiform aneurysms. Most IAs are saccular and typically occur at the arterial branching sites of the circle of Willis. Common sites of saccular IAs include the anterior communicating artery, the posterior communicating artery, internal carotid artery, the middle cerebral artery, and the basilar artery bifurcation. Although the exact pathogenesis of IA remains to be established, several hypotheses have highlighted the contribution of maladaptive vascular remodeling triggered by hemodynamic stress and inflammatory response1—a chain of events that would ultimately damage blood vessel walls and lead to IA. The worldwide prevalence of IA is estimated to be ≈3.2%.2 Subarachnoid hemorrhage (SAH) accounts for ≈5% of all strokes, and 85% of SAHs are because of aneurysmal ruptures. SAH has an incidence rate of 9 per 10 000 persons per year and a fatality rate ≈50%.3 The incidence of SAH is markedly higher in the Finnish and Japanese populations, but surprisingly, this is not because of the prevalence of IA in these populations.2 The most common clinical symptoms of aneurysmal SAH are a sudden onset of severe headache with stiff neck, vomiting, and photophobia. Unruptured IAs are usually asymptomatic and are identified through the screening of high-risk individuals or as incidental findings of magnetic resonance imaging, particularly magnetic resonance angiogram, or computerized tomographic studies. The diagnosis of IA is made by magnetic resonance angiogram, computerized tomographic angiography, or classical angiography. The diagnosis of …

Recent updates on echocardiography and ultrasound for Kawasaki disease: beyond the coronary artery

Kawasaki disease (KD) is a systemic vasculitis with a predilection for damage to the coronary arteries. In the acute phase, clinical decision making for KD relies on the measurements of the coronary z-score obtained by 2-dimensional echocardiography (2DE). In the convalescent phase, KD patients with coronary artery abnormalities (CAAs) eventually show arteriosclerotic vascular remodeling characterized by marked intimal proliferation and neoangiogenesis after KD vasculitis, which often induces myocardial ischemia. To date, several well-established surrogate markers including dobutamine stress echocardiography (DSE), the carotid intima-media thickness (CIMT) and flow-mediated dilatation (FMD), have been made available for risk assessment and the prediction of cardiovascular disease (CVD) in KD patients. Additionally, the use of carotid contrast-enhanced ultrasonography (CEUS), has enabled the visualization and quantification of the adventitial vasa vasorum (VV) network, assessing active vascular remodeling at remote arterial sites in KD patients with CAAs. However, there was no evidence of major vascular structural changes in KD patients in whom CAAs had never been detected. Thus, assessment of multiple modalities using 2DE may provide direct information not only on the vascular health but also on the stratification of the risk of CVD in KD patients with CAAs.

Abstract WP51: Currency of Collaterals: Validation and Clinical Utility of a Novel Imaging Paradigm for Triage to Endovascular Therapy

Background: The pivotal impact of collateral circulation on outcomes in endovascular therapy has fueled the development of numerous single and multiphase CTA collateral scales, yet synchronized validation with conventional angiography has never occurred. Multiphase flat detector CT angiography (mpFDCTA) enables direct patient transfer to the angiography suite and rapid collateral triage. We validated this novel collateral imaging paradigm and potential clinical utility for endovascular stroke treatment. Methods: Consecutive acute ischemic stroke patient data, including mpFDCTA followed within few minutes by digital subtraction angiography (DSA), in the setting of ICA or proximal MCA occlusions were analyzed. An independent core lab scored mpFDCTA with an established multiphase CTA collateral scale and separately graded ASITN collateral status on DSA, blind to all other data. Results: 24 consecutive cases (age 76.7 ± 7.3 years; 58.3% women; baseline NIHSS median 17 (4-23)) of acute stroke due to ICA or proximal MCA occlusion were analyzed with simultaneous mpFDCTA and DSA. Arterial occlusion sites included 18 M1 MCA, 5 ICA, 1 M2 MCA. ASPECTS was median 8 (4-10). Time from first noncontrast FDCT to intracranial DSA was 23.04 ± 7.6 minutes with mTICI ≥ 2b reperfusion in 91.7% of cases. mpFDCTA collateral score was median 3 (0-5) and DSA ASITN was median 2 (0-3), including the full range of potential collateral grades. mpFDCTA and ASITN were highly correlated (r=0.86, p&lt;0.001). mpFDCTA provided more complete collateral data compared to selective DSA injections in cases of ICAO. ROC analyses for prediction of clinical outcomes revealed an AUC of 0.76 for mpFDCTA collaterals and 0.70 for DSA ASITN collateral grades. Conclusions: Multiphase flat detector CT angiography (mpFDCTA) in the angiography suite provides a validated measure of collaterals, offering distinct advantages over conventional angiography. Direct patient transfer to the angiography suite and mpFDCTA collateral grading provides a novel and reliable triage paradigm for acute ischemic stroke.

Abstract WP396: Prior Doac Therapy is Related to Small Infarct Size and No Major Artery Occlusion in Patients With Acute Stroke and Nvaf

Background: Anticoagulant treatment with a vitamin K antagonist (VKA) has been reported to be associated with no major artery occlusion and small infarct volume. However, the effect of direct oral anticoagulant (DOAC) therapy on stroke volume or the site of arterial occlusion in acute ischemic stroke (AIS) patients is not well known. Methods: From March 2011 through July 2016, consecutive patients with AIS in the middle cerebral artery territory and non-valvular atrial fibrillation (NVAF) who underwent MRI were recruited. The infarct size was assessed by ASPECTS score on DWI, and the arterial occlusion site was evaluated on MR angiography. The effect of prior DOAC treatment on the site of arterial occlusion was assessed by multivariate ordinal logistic regression analysis. Results: A total of 345 patients (160 women; median age 79 years; median NIHSS score 12) were enrolled. Of these, 248 were on no anticoagulant, 45 were undertreated with a VKA, 24 were sufficiently treated with a VKA, and 28 were on a DOAC prior to the AIS. The DWI-ASPECTS on admission differed among the groups (median 7 in patients with no anticoagulant, 8 in undertreated VKA, 9 in sufficient VKA, and 9 in DOAC, p=0.002). Multivariate analysis showed that prior DOAC treatment was independently and negatively associated with more proximal artery occlusion (OR 0.39, p=0.031), compared to no anticoagulant. Conclusion: DOAC treatment prior to the event was associated with decreased risk of more proximal artery occlusion in AIS patients with NVAF, compared to no anticoagulation.

Response to Comment on "Retinal pulse wave velocity measurement using spectral-domain optical coherence tomography".

Spahr et al. recently commented on our latest paper "Retinal pulse wave velocity measurement using spectral-domain optical coherence tomography" with a conclusion that the measured retinal pulse wave velocity (rPWV) in our paper was contradictory to theoretical predictions and previously published results. However, the theoretical predictions by Spahr et al. based on Moens-Korteweg equation are questionable, since the Moens-Korteweg equation should not be used for small arteries like retinal arteries. Previously, various measurements of rPWV using different technologies have been reported. The results on human and rats are not consistent. As the rPWV is an unknown value, we argue that the time delay derived between 2 arterial sites should be verified to see if the delay truly represents the pulse wave transit time. In the future, special emphasis should be placed on demonstration of the reproducibility of technologies and data analysis of large samples.

Transcatheter Aortic Valve Implantation in Morphologically Complex Root Aneurysms

Performing transcatheter aortic valve implantation in the presence of aneurysmatic aortopathy is widely contraindicated but needs to be taken into account as a bailout strategy in selected patients. Deliberate preoperative assessment of measurements becomes the crucial key element in this context. After meticulous valve selection, retrograde access is obtained through the right subclavian artery additionally serving as a backup arterial cannulation site in case of conversion. Transcatheter aortic valve implantation is then performed through the transapical route. Transcatheter aortic valve implantation in complex aneurysmatic aortic morphology is feasible in highly selected patients after comprehensive preoperative evaluation. The present article describes our initial experience, safeguards, and technical details.

Physical Risk Factors of Hemorrhagic Complications Associated with Angio-Seal Closure Device Use in Neurointerventional Procedures.

Few studies have demonstrated detailed physical risk factors of hemorrhagic complications (HCs) associated with the Angio-Seal closure device. This retrospective study aimed to identify the risk factors of HC due to Angio-Seal use. Data from 143 cases that underwent neurointerventional procedures that involved puncturing the femoral artery and that used an Angio-Seal to close the puncture site were reviewed. We divided these cases into HC and no HC groups and retrospectively compared age, sex, past medical and preference history, body mass index (BMI), femoral artery depth, dual antiplatelet therapy use, activated clotting time, general anesthesia use, sheath size, right femoral artery puncture, and treatment time. HC occurred in 7 cases, 2 of which were excluded because of technical failure. Accordingly, we examined physical risk factors in 5 cases (3.5%) in the HC group and in 136 cases (96.5%) in the no HC group. A low BMI and shallow femoral artery depth were significantly associated with HC, whereas the other factors were not. A receiver operating characteristic curve indicated that a BMI cut-off value of 20.98 and a femoral artery depth of 11.1 mm could achieve optimal diagnostic efficiency for predicting HC. Patients with a BMI <21 may require careful hemostasis monitoring, and it is better not to undergo arterial puncture site closure using Angio-Seal for those with a femoral artery depth <11.1 mm.

Successful microsurgical treatment of intracranial aneurysms in infants: a retrospective study and literature review.

Intracranial aneurysms are extremely rare in infants, especially less than 1year old. This study aimed to analyze the frequency of infantile intracranial aneurysm in our department and investigate the clinical characteristics, treatment strategies, and outcomes of this disease. Six infants under 1year old in 4350 patients with intracranial aneurysms were retrospectively analyzed from January 2010 to December 2016. The patients (5 females and 1 male) ranged in age from 2 to 11 (mean age, 4.67) months. Four patients presented with generalized seizure and vomiting, 3 showed lethargy, 1 presented eye deviation, and 1 had right-sided hemiparesis. Radiographically, two aneurysms were localized in the middle cerebral artery (MCA) of the M2 segment, two were located in the M3 segment of MCA, one was located at left MCA bifurcation, and one was located at the nonbranching site of the left supraclinoid internal carotid artery. All these lesions were successfully managed with aneurysm clipping or resection, and the improvement of neurological deficits was achieved in all patients. Intracranial aneurysms should be considered in the differential diagnosis of infants who present with acute raised intracranial pressure. An improvement of neurological deficits is noted in infants who are managed promptly with microsurgical techniques of clipping during the long-term follow-up.

Machine and sonographer dependence for detecting coronary flow at the site of the proximal left coronary artery using transthoracic Doppler echocardiography

Machine and sonographer dependence for detecting coronary flow at the site of the proximal left coronary artery using transthoracic Doppler echocardiography

Side Branch Occlusion Determinants in Bifurcation Lesions Treated with Provisional Stenting Technique

It is well known that because of turbulence flow and shear stress, bifurcation sites of coronary arteries are vulnerable to atherosclerotic disease. Bifurcation lesions comprise 15% to 20% of all coronary lesions. Bifurcation lesions are treated by either using provisional or double stent technique. The main drawback of provisional stenting is side branch occlusion. We aimed to investigate the predictors of side branch occlusion in provisional stenting technique. We enrolled 803 patients (231 female, 572 male, average age 60.5 ± 12.0) whose bifurcation coronary lesions treated by provisional stenting in Adana Numune Education and Training Centre. Demographic, angiographic and interventional data’s are recorded. 182 patients (22.7%) admitted to hospital with stable angina and 621 (77.3%) with acute coronary syndrome (or unstable angina). 582 (72.5%) patients had left anterior descending artery, 166 (20.7%), circumflex and 55 (6.8%) right coronary artery as the culprit vessel. Side branch occlusion occurred in 52 patients (6.5%). Need for side branch intervention occurred in 160 patients. The predictors of need for side branch intervention were, multivessel disease, type of main branch stent, oversize of stent, presence of side branch disease before intervention, TIMI frame count (TFC) and the alpha angle. In conclusion multivessel disease, type of main branch stent, oversize of stent, presence of side branch disease before intervention, TIMI frame count (TFC) and the alpha angle were independent predictors of need for side branch intervention.

Experience With the Axillary Artery as an Arterial Cannulation Site in Patients With Type A Aortic Dissection

Experience With the Axillary Artery as an Arterial Cannulation Site in Patients With Type A Aortic Dissection

Generalized Regression Estimator Improved the Accuracy Rate of Estimated Dialysis Accesses Stenotic Condition on In-Vitro Arteriovenous Graft Experimental Model

Dialysis vascular accesses are critical for patients receiving hemodialysis treatment. However, dialysis access stenosis and further dysfunction are engendered by thrombosis or outflow (venous anastomosis site) stenosis and the progression of inflow (arterial anastomosis site) stenosis. Thus, any narrowed access causes vibrations, turbulent flow, and murmur sounds around stenosis sites. Auscultation and frequency-based techniques are employed to detect these sounds, and frequency components are also validated on the basis of the degree of stenosis (DOS). In this paper, a biophysical experimental model employing an in vitro arteriovenous graft model was established to produce various acoustic signals associated with single stenosis and multiple stenoses. By analyzing various combinations of stenoses, this paper selected suitable features of the frequency and power spectra using the Burg autoregressive method. A multiple regression model applying a higher number of explanatory variables and response variables, as a generalized regression neural network, was employed to identify DOS levels at inflow and outflow sites. The experimental results indicated that the proposed screening model provided a higher average hit rate of >90%, average true-positive rate of >90%, and true-negative rate of 100% in single and multiple stenosis screening, compared with the multiple linear regression model.

Unusual presentation of Takayasu's arteritis with cardiac involvement and renal artery stenosis

Takayasu's arteritis (TA) is a chronic large-vessel arteritis in which the aorta, its major branches, and the pulmonary arteries are affected. The clinical signs of TA are insidiously varied, depending on the arterial sites involved. In this paper, we report an unusual presentation of TA with signs and symptoms of heart failure and the involvement of the renal artery in a 34-year-old male who was managed with medical treatments and an interventional procedure. Given the unusual presentation of TA, we recommend a high clinical index of suspicion of renal artery involvement and sufficient heed to its significance especially in view of the fact that its early diagnosis and timely appropriate treatment can confer a much better prognosis.

Effects of carbon dioxide insufflation on anastomosis remodeling at a carotid artery site in rabbits.

IntroductionUse of carbon dioxide (CO2) insufflation (CDI) on the surgical field during heart surgery has become widespread, and in some units routine.AimTo assess the effects of CDI on endothelial dysfunction in a carotid artery model in rabbits.Material and methodsTwelve randomly selected rabbits were divided into two groups. Right carotid arteries of the animals were transected and sutured with running suture technique. Then, 1 l/min CO2 insufflation was initiated with a 45° angle. In the control group, the anastomotic field was irrigated with 0.1 ml/s flow of 0.9% saline. At day 28, the carotid artery segments were removed and prepared for histological specimens.ResultsIn the cross-sections of the control group vessel samples, thickening of the tunica intima was observed. Scoring the quantity of endothelial nitric oxide synthase (e-NOS) and α-smooth muscle actin (α-SMA) positive staining revealed a nonsignificant difference between the experimental groups (p = 0.07). In the CO2 group, the intimal hyperplasia (p = 0.2) and the thickness of the tunica media (p = 0.2) were indistinguishable when compared to the control group. The mean luminal diameters and luminal areas of the experimental groups were all evaluated by histomorphometry and a significant differences was found between luminal areas (p = 0.016). On the other hand, no significant difference was found between mean luminal diameters (p = 0.055).ConclusionsOur study indicated that CDI can affect endothelial cell damage and the mean luminal diameters.

In elective arch surgery with circulatory arrest, does the arterial cannulation site really matter? A propensity score analysis of right axillary and innominate artery cannulation

ObjectiveThe preferred arterial cannulation site for elective proximal aortic procedures requiring circulatory arrest varies, and different sites have been tried. We evaluated the relationships between arterial cannulation site and adverse outcomes, including stroke, in patients undergoing elective aortic arch surgery. MethodsWe reviewed the records of 938 patients who underwent elective hemiarch or total arch surgery with circulatory arrest between 2006 and 2016. Five cannulation sites were used: the right axillary (n = 515; 54.9%), innominate (n = 376; 40.1%), and right common carotid arteries (n = 15; 1.6%), each with a side graft; the ascending aorta (n = 19; 2.0%); and the femoral artery (n = 13; 1.4%). Multivariable logistic regression analysis was used to model the effects of cannulation site on adverse outcomes for the entire cohort and for a subcohort of 891 patients who underwent innominate or axillary artery cannulation. Propensity-matching yielded 564 patients (282 pairs) from the right axillary and innominate artery groups. ResultsFor the entire cohort, mortality, stroke, and composite adverse outcome (operative death or persistent stroke or renal failure at hospital discharge) rates were 7.0%, 4.1%, and 9.8%. In the multivariable analysis of the axillary/innominate subcohort, cannulation site did not independently predict operative mortality, persistent stroke, or composite adverse event. These results were confirmed with the propensity-matched analysis, where both axillary and innominate artery cannulation provided equivalent composite adverse event rates, operative death rates, and overall stroke rates. ConclusionsDuring elective arch surgery, right axillary artery cannulation and innominate artery cannulation (both via a side graft) produce excellent results and can be used interchangeably.