Subclavian-Axillary Access for Transcatheter Aortic Valve Implantation with SAPIEN 3: Results from the ACCESS Study

Dahle, Thom G.; Stegman, Brian; Dutcher, Jacob R.; Schmidt, William D.; Danielson, Daren; Teskey, John M.; Reed, Michael C.; Long, Susan K. De; Kliger, Chad; Brinster, Derek R.; Kaneko, Tsuyoshi; Shah, Pinak; Nores, Marcos; Rothenberg, Mark; Chawla, Atul; McAllister, David W.; Dezell, Sara J.; Castro, Nathaniel J.

doi:10.1080/24748706.2020.1822566

Cited by 2 publications

(1 citation statement)

References 22 publications

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“…73 Several studies have demonstrated a higher incidence of stroke in largebore subclavian/axillary access for TAVR compared with traditional femoral access, which may be related to the access itself or to the inherent stroke risk in patients with a degree of vascular disease that ultimately precluded them from femoral access. [74][75][76][77] Given this concern for neurologic sequelae, axillary access should only be considered in patients lacking traditional femoral access in whom revascularization with MCS is viewed as the best treatment option.…”

Section: Alternative Access Sites: Axillary Accessmentioning

confidence: 99%

Strategies for Reducing Vascular and Bleeding Risk for Percutaneous Left Ventricular Assist Device-supported High-risk Percutaneous Coronary Intervention

Vetrovec¹,

Kaki²,

Wollmuth³

et al. 2022

Heart International

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In patients at high risk for haemodynamic instability during percutaneous coronary intervention (PCI), practitioners are increasingly opting for prophylactic mechanical circulatory support, such as the Impella® heart pump (Abiomed, Danvers, MA, USA). Though Impellasupported high-risk PCI (HRPCI) ensures haemodynamic stability during the PCI procedure, access-related complication rates have varied significantly in published studies. Reported variability in complication rates relates to many factors, including anticoagulation practices, access and closure strategy, post-procedure care and variations in event definitions. This article aims to outline optimal strategies to minimize vascular and bleeding complications during Impella-supported HRPCI based on previously identified clinical, procedural and postprocedural risk factors. Practices to reduce complications include femoral skills training, standardized protocols to optimize access, closure, anticoagulation management and post-procedural care, as well as the application of techniques and technological advances. Protocols integrating these strategies to mitigate access-related bleeding and vascular complications for Impella-supported procedures can markedly limit vascular access risk as a barrier to appropriate large-bore mechanical circulatory support use in HRPCI.

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