Axillary Artery Access for Mechanical Circulatory Support Devices in Patients With Prohibitive Peripheral Arterial Disease Presenting With Cardiogenic Shock

Kaki, Amir; Blank, Nimrod; Alraies, M. Chadi; Jani, Alap R; Shemesh, Adi; Kajy, Marvin; Laktineh, Amir; Hasan, Reema; Gade, Christina; Mohamad, Tamam; Elder, Mahir; Schreiber, Theodore

doi:10.1016/j.amjcard.2019.02.033

Cited by 15 publications

(17 citation statements)

References 18 publications

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“…In total, 74 studies were screened for eligibility, and 22 studies met inclusion criteria and were included in the final analysis. 1,10,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]…”

Section: Search Resultsmentioning

confidence: 99%

“…It is divided into 3 segments based on proximity to the pectoralis minor muscle, with the first segment positioned medially, the second segment posterior, and the third segment lateral in position relative to the muscle. 1,2 The axillary artery runs superficially along the deltopectoral groove and continues to become the brachial artery at the location of the teres major muscle. On angiography, the vessel segments can be identified by the location of the axillary branch vessels, with the superior thoracic artery emerging from the first segment, the lateral thoracic and thoracoacromial arteries arising from the second segment, and the subscapular and circumflex humeral arteries from the third segment.…”

Section: Axillary Artery Anatomymentioning

confidence: 99%

“…8 Since then, there has been a growing body of evidence that pTAX access can be performed safely with minimal comorbidity, and with adequate hemostasis achievable via compression of the artery against the second rib. 1,2,9,10 The technique for pTAX access has been well described elsewhere. 1,2,[11][12][13] Under moderate sedation, an alternative access is obtained (ipsilateral radial, or femoral artery) and a wire is placed in the axillary artery.…”

Section: Percutaneous Axillary Access Techniquementioning

confidence: 99%

“…1,2,9,10 The technique for pTAX access has been well described elsewhere. 1,2,[11][12][13] Under moderate sedation, an alternative access is obtained (ipsilateral radial, or femoral artery) and a wire is placed in the axillary artery. A combination of angiography and ultrasound guidance is used to identify vessel landmarks and facilitate arterial puncture.…”

Section: Percutaneous Axillary Access Techniquementioning

confidence: 99%

“…increases the risk of vascular complications, raising the need for alternative access sites including transaxillary (TAX), transcaval and transcarotid approaches. [1][2][3][4] More recently, intravascular lithotripsy to the iliofemoral system has been used to facilitate access for transfemoral TAVR, although this remains off-label and patient data is limited. 5 The axillary artery appears to be a practical option for percutaneous access in these cases of hostile PVD, with the potential to reduce operating room utilization and procedure time, but the safety of percutaneous transaxillary (pTAX) access compared with more traditional surgical transaxillary (sTAX) access is not well established.…”

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confidence: 99%

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Percutaneous large‐bore axillary access is a safe alternative to surgical approach: A systematic review

Southmayd

Hoque

Kaki

et al. 2020

Cathet Cardio Intervent

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Objectives: To systematically review relevant literature regarding cardiovascular outcomes of large-bore axillary arterial access via percutaneous and surgical approaches. Background: In patients with severe peripheral arterial disease (PAD) undergoing cardiac interventions, large-bore femoral access may be prohibitive. The axillary artery provides an alternative vascular access for transcatheter aortic valve replacement (TAVR) or mechanical circulatory support. There have been limited comparisons of percutaneous transaxillary (pTAX) approach with the more traditional surgical transaxillary (sTAX) approach. Methods: Pubmed and Medline databases were queried through January 2019 for studies describing pTAX or sTAX approaches with TAVR or Impella insertion. Primary outcomes were access-related mortality, 30-day mortality, stroke, major vascular complications, and major bleeding. Results: One hundred and fifty five studies were reviewed, with additional unpublished data from 1 institution. Twenty-two studies met the inclusion criteria. Patient data was heterogeneous, with 69% TAVR and 31% Impella use in the pTAX group, and 96% TAVR and 4% Impella use in the sTAX group. There was more cardiogenic shock in the pTAX group. When compared to surgical approach, the percutaneous approach had similar 30-day mortality for TAVR (5.6% vs 4.6%, OR nonsignificant) and Impella (43.4% vs 38.6%, OR non-significant), similar stroke rates (4.3% vs 4.2%, OR non-significant), similar major vascular complications (2.8% vs 2.3%, OR non-significant) and less major bleeding (2.7% vs 17.9%, OR significant). Conclusions: Data suggests large-bore pTAX access has similar 30-day mortality, stroke rates, and major vascular complications as sTAX access, with less major bleeding. Additional studies are needed to validate results.

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Section: Search Resultsmentioning

confidence: 99%

Section: Axillary Artery Anatomymentioning

confidence: 99%

Section: Percutaneous Axillary Access Techniquementioning

confidence: 99%

Section: Percutaneous Axillary Access Techniquementioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Percutaneous large‐bore axillary access is a safe alternative to surgical approach: A systematic review

Southmayd

Hoque

Kaki

et al. 2020

Cathet Cardio Intervent

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Complications of Temporary Percutaneous Mechanical Circulatory Support for Cardiogenic Shock: An Appraisal of Contemporary Literature

et al. 2019

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Cardiogenic shock (CS) is associated with hemodynamic compromise and end-organ hypoperfusion due to a primary cardiac etiology. In addition to vasoactive medications, percutaneous mechanical circulatory support (MCS) devices offer the ability to support the hemodynamics and prevent acute organ failure. Despite the wide array of available MCS devices for CS, there are limited data on the complications from these devices. In this review, we seek to summarize the complications of MCS devices in the contemporary era. Using a systems-based approach, this review covers domains of hematological, neurological, vascular, infectious, mechanical, and miscellaneous complications. These data are intended to provide a balanced narrative and aid in risk-benefit decision-making in this acutely ill population.

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Deploying Mechanical Circulatory Support Via the Axillary Artery in Cardiogenic Shock and High-Risk Percutaneous Coronary Intervention

Kajy

Laktineh

Blank

et al. 2020

The American Journal of Cardiology

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Axillary Artery Access for Mechanical Circulatory Support Devices in Patients With Prohibitive Peripheral Arterial Disease Presenting With Cardiogenic Shock

Cited by 15 publications

References 18 publications

Percutaneous large‐bore axillary access is a safe alternative to surgical approach: A systematic review

Percutaneous large‐bore axillary access is a safe alternative to surgical approach: A systematic review

Complications of Temporary Percutaneous Mechanical Circulatory Support for Cardiogenic Shock: An Appraisal of Contemporary Literature

Deploying Mechanical Circulatory Support Via the Axillary Artery in Cardiogenic Shock and High-Risk Percutaneous Coronary Intervention

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