Outcomes Following Subclavian and Axillary Artery Access for Transcatheter Aortic Valve Replacement

Dahle, Thom G.; Kaneko, Tsuyoshi; McCabe, James M.

doi:10.1016/j.jcin.2019.01.219

Cited by 136 publications

(74 citation statements)

References 21 publications

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“…Alternative vascular approaches are advantageous or even mandatory in patients presenting certain anatomy. [6][7][8][9] In this series, 34.1% of patients had stage II Glenn palliation in single-ventricle physiology requiring access from the neck if the SVC and pulmonary arteries were targeted. In addition, access to the jugular and subclavian veins is an option if the IVC is absent, aberrant, stenotic, thrombosed or simply too small, which may also affect the femoral and pelvic vessels.…”

Section: Discussionmentioning

confidence: 86%

Catheter strategy to ease the procedure and reduce radiation exposure when requiring neck access

et al. 2020

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ObjectivesTo assess the potential occupational radiation reduction and technical feasibility in patients rotated 180° (upside-down) when requiring neck access for transcervical or trans-subclavian catheterisation.MethodsUpside-down positioning is defined as rotating patients in supine position by 180°, so that the feet come to rest where the head would otherwise be. We retrospectively evaluated all these procedures performed between March 2016 and May 2019. Furthermore, two different phantoms (paediatric and adult) were used prospectively to quantify the occupational dose between conventional or upside-down positioning. In this context, ambient dose equivalents were measured using real-time dosimeters. Three different projection angles were applied.Results44 patients with median age and body weight of 1.0 year (range 0–56) and 9.5 kg (range 1.3–74.3) underwent 63 procedures positioned upside-down. This position proved advantageous for practical reasons, since the length of the examination table could be optimally used. Additionally, it resulted in a significantly lower overall ambient dose equivalent for the primary operator (PO) of 94.8% (mean: 2569±807 vs 135±23 nSv; p<0.01) in the adult, and of 65.5% (mean: 351±104 vs 121±56 nSv; p<0.01) in the paediatric phantom, respectively.ConclusionUpside-down positioning facilitates handling in a straightforward manner when access from the neck is required. Moreover, it significantly reduces local radiation exposure for the PO in the paediatric and, most impressively, in the adult phantom.

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Section: Discussionmentioning

confidence: 86%

Catheter strategy to ease the procedure and reduce radiation exposure when requiring neck access

et al. 2020

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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%

“…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%

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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“…It is worth emphasising that two recent studies demonstrated higher stroke rates in patients undergoing TAVR via an AA approach compared TraNscathetER Valves (PARTNER) II trial. 1,16 It remains unclear if this is due to patient-related factors, including peripheral vascular disease requiring alternative access, or crossing the head and neck vessels, and interestingly it was not associated with mortality. 1 Further investigation into the mechanism and risk of stroke with surgical and percutaneous AA approaches, including indwelling devices, is warranted.…”

Section: Management Of Complicationsmentioning

confidence: 99%

Emerging Role of Large-bore Percutaneous Axillary Vascular Access: a Step-by-step Guide

et al. 2020

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Advances in transcatheter structural heart interventions and temporary mechanical circulatory support have led to increased demand for alternative sites for large-bore vascular access. Percutaneous axillary artery access is an appealing alternative to femoral access in patients with peripheral arterial disease, obesity or for prolonged haemodynamic support where patient mobilisation may be valuable. In particular, axillary access for mechanical circulatory support allows for increased mobility while using the device, facilitating physical therapy and reducing morbidity associated with prolonged bed rest. This article outlines the basic approach to percutaneous axillary vascular access, including patient selection and procedure planning, anatomic axillary artery landmarks, access techniques, sheath removal and management of complications.

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Outcomes Following Subclavian and Axillary Artery Access for Transcatheter Aortic Valve Replacement

Cited by 136 publications

References 21 publications

Catheter strategy to ease the procedure and reduce radiation exposure when requiring neck access

Catheter strategy to ease the procedure and reduce radiation exposure when requiring neck access

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

Emerging Role of Large-bore Percutaneous Axillary Vascular Access: a Step-by-step Guide

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