“…No patient required vascular surgery, nor did anyone experience brachial plexus injury or pneumothorax. Moreover, contrary to other reports that used the first axillary segment for endovascular aortic procedures, none of our patients suffered a stroke 12 , 13 . However, attributing such a difference to the specifics of aortic versus cardiac interventions is challenging, and it should rather be considered a matter of chance.…”
Percutaneous transaxillary approach (PTAX) through the first segment of the axillary artery is not widely recognized as a safe method. Furthermore, PTAX has never been directly compared between Impella-supported percutaneous coronary interventions (Impella-PCI) and transcatheter aortic valve replacement (TAVR). This study evaluated the feasibility and safety of PTAX through the first axillary segment in Impella-PCI versus TAVR. In cases where standard imaging guidance was insufficient, a technique involving puncturing the axillary artery “on-the-balloon” was employed. The endpoints were bleeding and vascular complications, as defined by BARC and VARC-3 criteria. PTAX was successfully performed in all 46 attempted cases: 23 for Impella-PCI and 23 for TAVR. Strict adherence to BARC and VARC-3 criteria led to the frequent identification of major bleeding (57%) and a moderately frequent diagnosis of vascular complications (17%). These incidences were primarily based on post-procedural hemoglobin reduction (> 3 g/dl) but not overt bleeding. The Impella group exhibited a higher rate of BARC 3b bleeding due to a greater hemoglobin decline resulting from the prolonged implant duration and PCI itself. Left axillary access was linked to smaller blood loss. Bleeding and vascular complications, as per BARC and VARC-3 definitions, did not affect short-term prognosis, with only 3 Impella patients succumbing to heart failure unrelated to the procedures during one-month follow-up period.
“…No patient required vascular surgery, nor did anyone experience brachial plexus injury or pneumothorax. Moreover, contrary to other reports that used the first axillary segment for endovascular aortic procedures, none of our patients suffered a stroke 12 , 13 . However, attributing such a difference to the specifics of aortic versus cardiac interventions is challenging, and it should rather be considered a matter of chance.…”
Percutaneous transaxillary approach (PTAX) through the first segment of the axillary artery is not widely recognized as a safe method. Furthermore, PTAX has never been directly compared between Impella-supported percutaneous coronary interventions (Impella-PCI) and transcatheter aortic valve replacement (TAVR). This study evaluated the feasibility and safety of PTAX through the first axillary segment in Impella-PCI versus TAVR. In cases where standard imaging guidance was insufficient, a technique involving puncturing the axillary artery “on-the-balloon” was employed. The endpoints were bleeding and vascular complications, as defined by BARC and VARC-3 criteria. PTAX was successfully performed in all 46 attempted cases: 23 for Impella-PCI and 23 for TAVR. Strict adherence to BARC and VARC-3 criteria led to the frequent identification of major bleeding (57%) and a moderately frequent diagnosis of vascular complications (17%). These incidences were primarily based on post-procedural hemoglobin reduction (> 3 g/dl) but not overt bleeding. The Impella group exhibited a higher rate of BARC 3b bleeding due to a greater hemoglobin decline resulting from the prolonged implant duration and PCI itself. Left axillary access was linked to smaller blood loss. Bleeding and vascular complications, as per BARC and VARC-3 definitions, did not affect short-term prognosis, with only 3 Impella patients succumbing to heart failure unrelated to the procedures during one-month follow-up period.
“…Furthermore, transaxillary percutaneous access has been associated with considerable rates of open conversion and adjunctive endovascular procedures. 4 Figure 6 Device Designs for Total Femoral Approach and Axillary Approach ( A ) Femoral; ( B ) axillary. …”
“…The literature also offers data on percutaneous access of the axillary artery, which has been reported to have a low conversion and reintervention rate, using even larger sheath sizes. 10,20,[25][26][27] However, the above-mentioned meta-analysis by Malgor et al 17 also found percutaneous AA to be inferior to a surgical approach regarding the access complication rate.…”
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