Percutaneous transaxillary approach for peripheral endovascular interventions

Abstract

Objectives To assess the safety and feasibility of percutaneous transaxillary (TAx) access for peripheral endovascular interventions. Background The common femoral artery (CFA) is the most commonly used access site for peripheral endovascular interventions. However, its use might be precluded in multiple circumstances. The axillary artery is comparable in size to the CFA and is less affected by atherosclerosis. Data regarding its percutaneous use in peripheral endovascular interventions are scarce. Methods Consecutive patients who underwent percutaneous TAx peripheral endovascular interventions were identified. Demographic and periprocedural data were extracted. Axillary artery access was obtained percutaneously with the arm abducted. A destination sheath was advanced to the relevant vessel. Endovascular interventions were performed using standard devices and techniques. Vascular closure devices were utilized to achieve hemostasis. Primary endpoints included procedural technical success, access‐related complications, and major adverse events (MAEs). Secondary endpoints included cannulation time, total procedure time, fluoroscopy time, and length of stay (LOS). Results Percutaneous TAx access was successfully utilized to perform 41 procedures in 29 patients, lacking a suitable conventional access. Three quarters of target vessels were infrainguinal. The lesions of 61% were classified as TransAtlantic Inter‐Society Consensus (TASC) C or D. Access‐related complications occurred in two procedures (5%). No MAEs occurred. Median cannulation time was 12 min, procedure time 135 min, fluoroscopy time 20 min, and LOS 1 day. Conclusions When no suitable access exists for lower extremity catheter‐based interventions, percutaneous TAx approach is a feasible and safe alternative. As such facility with this approach is a valuable asset for interventionalists.

Technical Consideration of Endovascular Treatment for Aortoiliac Occlusive Disease Based on a 10-Year Tertiary Hospital Experience: A Retrospective Study

“…In this study, the femoral and brachial approaches were performed in 17 patients, the majority of whom TASC C & D lesions, with a technical success rate of approximately 94.1%. Thawabi et al ( 12 ) reported a high technical success rate (97.5%, 40/41) in the transaxillary approach for patients with unsuitable femoral access; however, there was a 5% puncture-site-related complication rate. Millon et al ( 6 ) reported only the brachial approach, with a 93% technical success rate for extensive AIOD involving distal aortic occlusion ( 13 ).…”

Percutaneous Axillary Artery Access for Lithoplasty of a Heavily Calcified Iliac Artery Chronic Total Occlusion

“…Percutaneous axillary access has been shown to be a reasonable alternative to brachial access for endovascular therapy of complex aortoiliac disease 1 given the high complication rate of the latter 2 and the better anatomical suitability for percutaneous axillary closure and bailout stenting. 3,4 A shallow angle of axillary needle entry is key 5 ; however, a longer than 7 cm micropuncture needle was not available here.…”