Caliber and fitness of the axillary artery as a conduit for large‐bore cardiovascular procedures

Arnett, Daniel M; Lee, James C.; Harms, Michael A.; Kearney, Kathleen; Ramos, Mario; Smith, Bryn M.; Anderson, Emily C.; Tayal, Rajiv; McCabe, James M.

doi:10.1002/ccd.27416

Cited by 58 publications

(34 citation statements)

References 19 publications

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“…The axillary artery has emergent as a feasible alterative access route for percutaneous large‐bore access in patients with unsuitable iliofemoral arteries. A recent multi‐detector axial tomographic comparative analysis of axillary and iliofemoral arteries in 208 patients revealed that axillary artery was slightly smaller than the common femoral artery (mean minimal luminal diameter = 6.0 ± 1.1 mm and 6.6 ± 1.8 mm, P < 0.01) but was less likely to have a significant stenosis (2% vs 12%, P < 0.01) or moderate to severe calcifications (9% vs 64%, P < 0.01) …”

Section: Discussionmentioning

confidence: 99%

“…These alternatives usually require surgical exposure and are often associated with increased morbidity and longer hospitalizations . Percutaneous transaxillary large‐bore access has been recently described as a promising alternative for patients with inadequate femoral access . We provide a step‐by‐step guide for percutaneous axillary access and closure for the insertion of a left ventricular assist device.…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous axillary access for large-bore arteriotomy: A step-by-step guide

et al. 2018

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The last decade has witnessed a tremendous growth in the type and complexity of transcatheter cardiovascular interventions that require large-bore access. While the common femoral artery has become the main route for these interventions, sizable cohorts of patients are unsuitable for transfemoral access due to vascular disease or small vessel caliber. Percutaneous axillary access has emerged as a feasible alternative in these patients. We provide a step-by-step guide for transaxillary large-bore access and closure for patients requiring transcatheter interventions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Percutaneous axillary access for large-bore arteriotomy: A step-by-step guide

et al. 2018

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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 .…”

Section: Axillary Alternative Access Occlusive Sheathmentioning

confidence: 99%

Large bore occlusive sheath management

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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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“…5 mm has also been suggested. 8 Calcified vessels are more prone to dissection or distal embolisation and can lead to challenges deploying closure devices at the time of explant. 10 For this reason, heavy calcification of the AA warrants additional consideration before large-bore access, aided by a detailed ultrasound assessment at the location of calcium within the arterial wall at the target site.…”

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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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Caliber and fitness of the axillary artery as a conduit for large‐bore cardiovascular procedures

Abstract: Objectives: We sought to describe the caliber and vascular health of the subclavian and axillary arteries as related to their potential utilization in complex cardiovascular procedures.Background: Patients referred for advanced catheter-based therapies frequently have lower

Cited by 58 publications

References 19 publications

Percutaneous axillary access for large-bore arteriotomy: A step-by-step guide

Percutaneous axillary access for large-bore arteriotomy: A step-by-step guide

Large bore occlusive sheath management

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

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