2.Axillary artery cannulation (**Figure 6**)

Introduced in 1990s [24], axillary artery cannulation is gaining greater acceptance among surgeons as they switch to an antegrade perfusion strategy. It is more commonly used in hemodynamically stable patients. Infraclavicular dissection exposes the first part of axillary artery [25]. The pectoralis major muscle is split. The neurovascular bundle is situated deep in the clavipectoral fascia. The deltopectoral approach exposes the second and third parts for cannulation [26]. The axillary artery can be directly cannulated or anastomosed with end to side 8 mm vascular graft. Advantages include (i) antegrade perfusion flow and (ii) can be used for antegrade cerebral perfusion by occluding innominate artery. Disadvantages of this approach include (i) takes more time than femoral cannulation especially in obese patients and (ii) technically more difficult and risk of injury to brachial plexus nerves.
