Insertion of the Impella via the axillary artery for high-risk percutaneous coronary intervention

Truong, Huu Tam; Hunter, Glenn C.; Lotun, Kapildeo; Shetty, Ranjith; Shanmugasundaram, Madhan; Kapoor, Divya; Thai, Hoang

doi:10.1016/j.carrev.2017.12.016

Cited by 18 publications

(20 citation statements)

References 10 publications

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“…Although it is typically smaller than the common femoral artery, the axillary artery has been shown to be an acceptable alternative access site for MCS in the presence of severe PAD . Both the left and right axillary arteries have been used for TAVR, and Impella insertion . Previously, published reports described the technique in patients presenting for high risk coronary interventions with stable hemodynamics .…”

Section: Axillary Alternative Access Occlusive Sheathmentioning

confidence: 99%

“…Both the left and right axillary arteries have been used for TAVR, and Impella insertion . Previously, published reports described the technique in patients presenting for high risk coronary interventions with stable hemodynamics . Prior to accessing the axillary artery A 5Fr JR4 guide catheter is advanced over a guidewire via the femoral artery and selectively engaged in the left SCA or innominate artery.…”

Section: Axillary Alternative Access Occlusive Sheathmentioning

confidence: 99%

“…22,23 Both the left and right axillary arteries have been used for TAVR, and Impella insertion. [24][25][26][27][28] Previously, published reports described the technique in patients presenting for high risk coronary interventions with stable hemodynamics. 27,29 Prior to accessing the axillary artery A 5Fr JR4 the axillary artery is performed to evaluate distal perfusion beyond the access point.…”

Section: Axillary Alternative Access Occlusive Sheathmentioning

confidence: 99%

“…[24][25][26][27][28] Previously, published reports described the technique in patients presenting for high risk coronary interventions with stable hemodynamics. 27,29 Prior to accessing the axillary artery A 5Fr JR4 the axillary artery is performed to evaluate distal perfusion beyond the access point. In rare cases, perfusion of the distal arm can be compromised especially when the axillary artery is less than 5.5 mm.…”

Section: Axillary Alternative Access Occlusive Sheathmentioning

confidence: 99%

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Large bore occlusive sheath management

Kaki

Alraies

Kajy

et al. 2019

Cathet Cardio Intervent

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The field of interventional cardiology has evolved in its ability to carry out complex procedures. Procedures such as transcatheter aortic valve replacement (TAVR), endovascular aneurysm repair (EVAR), and mechanical circulatory support (MCS) devices require large bore access for successful deployment. With the use of large bore‐access, comes with it an increased risk for vascular complications, such as thrombosis and limb ischemia. It is paramount for the interventional cardiologist to know how to manage such complications. In this manuscript, we describe our strategies for the management of occlusive sheaths increasingly encountered with large bore accesses in the upper and lower extremities. Strategies such as peeling away of the introducer sheath and the creation of internal and external bypass circuits are described. By using the described techniques, one can provide prolonged hemodynamic support and maintain large bore sheath access, without jeopardizing perfusion to the extremity.

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Section: Axillary Alternative Access Occlusive Sheathmentioning

confidence: 99%

Section: Axillary Alternative Access Occlusive Sheathmentioning

confidence: 99%

Section: Axillary Alternative Access Occlusive Sheathmentioning

confidence: 99%

Section: Axillary Alternative Access Occlusive Sheathmentioning

confidence: 99%

See 2 more Smart Citations

Large bore occlusive sheath management

Kaki

Alraies

Kajy

et al. 2019

Cathet Cardio Intervent

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show abstract

“…This seems an excellent indication, and several case reports and case series confirm the use of the transaxillary approach as an important alternative. It has been used in cases of hostile iliofemoral disease without a femoral access site in patients with cardiogenic shock, uncontrolled femoral access bleeding, left ventricular unloading during extracorporeal circulation, left ventricular support during high‐risk intervention, stabilization in severely decompensated heart failure, in fulminant myocarditis, and as a bridge to heart transplantation . Reviewing recently published cases, it seems that complication rates are low with no reports of brachial plexus injuries, upper extremity ischemia, or bleeding requiring intervention even with prolonged use.…”

mentioning

confidence: 99%

Transaxillary Impella support: Bridging the gap of powerful left ventricular support

2019

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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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Insertion of the Impella via the axillary artery for high-risk percutaneous coronary intervention

Cited by 18 publications

References 10 publications

Large bore occlusive sheath management

Large bore occlusive sheath management

Transaxillary Impella support: Bridging the gap of powerful left ventricular support

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

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