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Somers et al. Vessel Plus 2024;8:15 https://dx.doi.org/10.20517/2574-1209.2023.48 Page 7 of 9

Table 2. Postoperative characteristics of patients who underwent ATAAD surgery
Femoral Direct aortic P PSM FA PSM PSM P
cannulation cannulation Total value (n = 71) DA
(n = 145) (n = 129) (n = 274) (n = 71) value
Surgical mortality 17 (12) 10 (7.8) 27 (9.9) 0.271 7 (9.8) 3 (4.2) 0.190
New permanent neurological 10 (6.9) 14 (11) 24 (8.8) 0.248 3 (4.2) 8 (11) 0.117
damage
Reintervention for bleeding 34 (23) 37 (29) 71 (26) 0.324 14 (20) 23 (32) 0.085
< 48 h
> 48 h 14 (9.7) 8 (6.2) 22 (8.0) 0.294 6 (8.5) 3 (4.2) 0.493
20 (14) 29 (22) 49 (18) 0.061 8 (11) 20 (28) 0.011
Acute kidney injury 28 (19) 36 (28) 64 (23) 0.093 14 (20) 18 (25) 0.422
Requiring dialysis 6 (4.1) 10 (7.8) 16 (5.8) 0.561 3 (4.2) 5 (7.0) 0.666
Sternal infections 4 (2.8) 5 (3.9) 9 (3.3) 0.739 2 (2.8) 3 (4.2) 1.000
Groin wound problems 3 (2.1) 0 (0) 3 (1.1) 0.250 2 (2.8) 0 (0) 0.496
Hospital stay, days 15.9 ± 11.9 17.9 ± 15.4 16.8 ± 13.7 0.215 16.0 ± 12.7 18.6 ± 16.3 0.290

Values are mean ± SD or n (%). PSM: Propensity score matching; FA: femoral artery cannulation; DA: direct aortic cannulation.

Table 3. Follow-up characteristics of patients who underwent ATAAD surgery
Femoral cannulation Direct aortic cannulation Total P value
(n = 145) (n = 129) (n = 274)
Mean diameter descending aorta during follow-up 38.4 ± 9.5 39.9 ± 10.1 39.1 ± 9.8 0.272
Reoperations for dilatating ascending aorta (root or arch) 2 (1.4) 3 (2.3) 5 (1.8) 0.669
Postdissection reoperation 9 (6.2) 15 (12) 24 (8.8) 0.113
False aneurysm reoperation 3 (2.1) 2 (1.6) 5 (1.8) 1.000

Values are mean ± SD or n (%).

cannulation, which has previously been described as more favoring femoral over axillary cannulation due to
[30]
the close proximity of blood flow and renal artery .

Our current study has several limitations. As all patients are only from one clinic, results are difficult to
extrapolate. Second, the limited sample size might not be sufficient to detect a significant treatment effect.
Another limitation is the retrospective character with non-randomized choice of cannulation strategy,
which is based on the surgeon’s personal preference and patients’ clinical status. In addition, only four RAX
cannulations were performed during the study period, making the comparison between DA and RAX
cannulation outcomes impossible.

We believe DA cannulation has the best of both worlds: realizing antegrade flow similar to RAX
cannulation, while retaining the convenience and familiarity of the technique, as seen in FA
cannulation [2,11] . DA cannulation has the advantage over RAX cannulation with lower operating times due to
less complexity and more convenience, as shown in other reports [14,27,31] . Future research should focus on DA
cannulation for ATAAD patients and compare it to the other techniques offering antegrade flow, especially
RAX cannulation.

To conclude, DA cannulation offers a safe alternative to FA cannulation in ATAAD surgery, with no
significant differences in mortality, neurological complications, and reoperations. Therefore, the
conventional hesitance to touch the dissected aorta is unwarranted. Additionally, DA cannulation obviously
obviates the possibility of postoperative groin infections. Future studies should focus more on the