Efficacy of Manual Hemostasis for Percutaneous Axillary Artery Intra-Aortic Balloon Pump Removal

Abstract

Background. The prevalence of peripheral vascular disease has led to the re-emergence of percutaneous axillary vascular access as a suitable alternative access site to femoral artery. We sought to investigate the efficacy and safety of manual hemostasis in the axillary artery. Methods. Data were collected from a prospective internal registry of patients who had a Maquet® (Rastatt, Germany) Mega 50 cc intra-aortic balloon pumps (IABP) placed in the axillary artery position. They were anticoagulated with weight-based intravenous heparin to maintain an activated partial thromboplastin time (aPTT) of 50–80 seconds. Anticoagulation was discontinued 2 hours prior to the device explantation. Manual compression was used to achieve the hemostasis of the axillary artery. Vascular and bleeding complications attributable to manual hemostasis were classified based on the Valve Academic Research Consortium-2 (VARC-2) and Bleeding Academic Research Consortium-2 (BARC-2) classifications, respectively. Results. 29 of 46 patients (63%) achieved axillary artery homeostasis via manual compression. The median duration of IABP implantation was 12 days (range 1–54 days). Median compression time was 20 minutes (range 5–60 minutes). There were no major vascular or bleeding complications as defined by the VARC-2 and BARC-2 criteria, respectively. Conclusion. Manual compression of the axillary artery appears to be an effective and safe method for achieving hemostasis. Large prospective randomized control trials may be needed to corroborate these findings.

SCAI Position Statement on Best Practices for Percutaneous Axillary Arterial Access and Training

“…Manual compression of the axillary artery has been demonstrated to be a viable alternative to VCDs, particularly for sheath sizes <9F in patients who are not on anticoagulation (Figure 5). 11 Compression over or near the second rib may be the most effective location for hemostasis and avoidance of pseudoaneurysm formation. However, a developing hematoma in this location may be hard to appreciate given the anatomy and therefore upstream balloon tamponade during manual compression should be considered as a precaution.…”

Removal of the intra-aortic balloon pump: Why and in what way?

“…VCD applications can be used in IABP removal from different regions where hemostasis control can be difficult [5]. However, there are also studies indicating that manual compression is effective in IABP removal applications from the axillary artery [6].…”