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Cardona S, Gross AS, Yu AT, Bassily-Marcus A, Oropello J, Manasia A. Ultrasound-guided Axillary Artery Catheter Placement and Associated Complications in Critically Ill Patients. J Intensive Care Med 2024; 39:916-921. [PMID: 38794858 DOI: 10.1177/08850666241257417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
BACKGROUND Arterial catheter placement for hemodynamic monitoring is commonly performed in critically ill patients. The radial and femoral arteries are the two sites most frequently used; there is limited data on the use of the axillary artery for this purpose. The aim of this study was to investigate the rate of complications from ultrasound-guided axillary artery catheter placement in critically ill patients. METHODS A retrospective study at a tertiary care center of patients admitted to an intensive care unit who had ultrasound-guided axillary artery catheter placement during admission. Primary outcome of interest was catheter related complications, including bleeding, vascular complications, compartment syndrome, stroke or air embolism, catheter malfunction, and need for surgical intervention. RESULTS This study identified 88 patients who had an ultrasound-guided axillary artery catheter placed during their admission. Of these 88, nine patients required multiple catheters placed, for a total of 99 axillary artery catheter placement events. The median age was 64 [IQR 48, 71], 41 (47%) were female, and median body mass index (BMI) was 26 [IQR 22, 30]. The most common complication was minor bleeding (11%), followed by catheter malfunction (2%), and vascular complications (2%). Univariate analyses did not show any association between demographics and clinical variables, and complications related to axillary arterial catheter. CONCLUSION The most common complication found with ultrasound-guided axillary artery catheter placement was minor bleeding, followed by catheter malfunction, and vascular complications. Ultrasound-guided axillary arterial catheters are an alternative in patients in whom radial or femoral arterial access is difficult or not possible to achieve.
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Affiliation(s)
- Stephanie Cardona
- Department of Critical Care Medicine, The Mount Sinai Hospital, New York, NY, USA
| | - Aliza S Gross
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Allen T Yu
- Department of General Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Adel Bassily-Marcus
- Department of Critical Care Medicine, The Mount Sinai Hospital, New York, NY, USA
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - John Oropello
- Department of Critical Care Medicine, The Mount Sinai Hospital, New York, NY, USA
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Anthony Manasia
- Department of Critical Care Medicine, The Mount Sinai Hospital, New York, NY, USA
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
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Spencer TR, Imbriaco G, Bardin-Spencer A, Mahoney KJ, Brescia F, Lamperti M, Pittiruti M. Safe Insertion of Arterial Catheters (SIA): An ultrasound-guided protocol to minimize complications for arterial cannulation. J Vasc Access 2024; 25:1403-1408. [PMID: 37265235 DOI: 10.1177/11297298231178064] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Direct puncture and cannulation of peripheral arteries is frequently performed in critical care and in emergency settings, mainly for hemodynamic monitoring and blood sampling. While there is abundant literature on peripheral arterial cannulation in children and adults, there is still scope for clinical improvements which may impact on patient safety. Although the radial artery is the most frequently utilized access site today, due to its superficial proximity, ease of access, and low risk of adverse events, other sites are sometimes chosen. The authors propose the Safe Insertion of Arterial Catheters (SIA) protocol, an ultrasound-guided insertion bundle applying a systematic approach to arterial cannulation, with a focus on improving insertion practices, reducing procedural complications, increasing the patient safety profile, and improving device performance.
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Altaha MA, Bailey S, Mafeld S, Jaberi A, Tan KT. Axillary compared to brachial access for endovascular procedures. Vascular 2024:17085381241279142. [PMID: 39214135 DOI: 10.1177/17085381241279142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
OBJECTIVES Limited knowledge exists regarding access site complication rates between trans-axillary and trans-brachial approaches with sheath sizes ≥6Fr. We retrospectively reviewed our institution experience with access site complications for percutaneous trans-axillary and trans-brachial arterial interventions using sheath sizes ranging from 6Fr to 10Fr. METHODS We examined 67 endovascular interventions performed over 18 months, restricted to sheath sizes of 6Fr to 10Fr. Procedures utilizing trans-brachial (41 cases) and trans-axillary (26 cases) approaches under sonographic guidance were included. Cases involving hemodialysis accesses and those requiring surgical cut-down were excluded. The primary outcome measure was the occurrence of major access site complications (SIR grade-II/III) within 30 days, with data collected on hemostasis method, sheath size, and complications. Statistical analysis involved ANCOVA and Fisher's exact tests, with significance set at p < .05. RESULTS Successful percutaneous arterial access was achieved in all cases using either approach (trans-axillary or trans-brachial). Closure devices were employed in all axillary punctures and in 71% of brachial punctures. Major access site complications occurred in 7 out of 41 cases (17%) in the trans-brachial group and in 4 out of 26 cases (15%) in the trans-axillary group. However, there was no statistically significant difference in complication rates between the two groups, regardless of access site or sheath size. CONCLUSION Trans-axillary access serves as a safe and effective upper limb access method for percutaneous endovascular procedures requiring sheath size of 7Fr or larger when compared to trans-brachial approach.
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Affiliation(s)
- Mustafa A Altaha
- Division of Vascular and Interventional Radiology, Joint Department of Medical Imaging, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Shawn Bailey
- Division of Vascular and Interventional Radiology, Joint Department of Medical Imaging, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Sebastian Mafeld
- Division of Vascular and Interventional Radiology, Joint Department of Medical Imaging, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Arash Jaberi
- Division of Vascular and Interventional Radiology, Joint Department of Medical Imaging, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Kong Teng Tan
- Division of Vascular and Interventional Radiology, Joint Department of Medical Imaging, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
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Al Adas Z, Uceda D, Mazur A, Zehner K, Agrusa CJ, Wang G, Schneider DB. Safety and learning curve of percutaneous axillary artery access for complex endovascular aortic procedures. J Vasc Surg 2024; 79:487-496. [PMID: 37918698 DOI: 10.1016/j.jvs.2023.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/20/2023] [Accepted: 10/27/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Percutaneous axillary artery access is increasingly used for large-bore access during interventional vascular and cardiac procedures. The aim of this study was to evaluate the safety and learning curve of percutaneous axillary artery access in patients undergoing complex endovascular aortic repair (fenestrated and branched endovascular aneurysm repair [FBEVAR]) requiring large-bore upper extremity access and to discuss best practices for technique and complication management. METHODS One-hundred forty-six patients undergoing large-bore percutaneous axillary artery access during FBEVAR in a prospective, nonrandomized, Investigational Device Exemption study between September 2017 and January 2023 were analyzed. Ultrasound guidance and micropuncture were used to access the second portion of the axillary artery and 2 Perclose Proglide or Prostyle devices (Abbott Vascular) were predeployed before the insertion of the large-bore sheath. Completion angiography was performed in all patients to verify hemostatic closure. Axillary artery patency was also assessed on follow-up computed tomography angiography. Patient-related, procedural, and postoperative variables were collected and analyzed. RESULTS One-hundred forty-five patients underwent successful percutaneous axillary artery access; 1 patient failed axillary access and alternative access was established. The left axillary artery was accessed in 115 patients (79%), and the right axillary artery was accessed in 30 patients (21%). The largest profile sheath was 14 F in 4 patients (2.8%), 12F in 133 patients (91.7%), and 8F in 8 patients (5.5%). Ten patients (6.9%) required covered stent placement (Viabahn, W. L. Gore & Associates) for failure to achieve hemostasis; there were no conversions to open surgical repair. Additional adverse events included transient upper extremity weakness in two patients (1.3%) and transient upper extremity paresthesias in two patients (1.3%). Three patients (2%) suffered postoperative strokes, including one unrelated hemorrhagic stroke and two possibly access-related embolic strokes. On follow-up, axillary artery patency was 100%. There was a trend toward decreased closure failure over time, with seven patients (10%) in the early cohort and three (4%) in the late cohort. There was a significant negative correlation between the cumulative complication rate and the cumulative experience. CONCLUSIONS Large-bore percutaneous axillary artery access provides safe upper extremity large-bore access during FBEVAR, achieving successful closure in >90% of patients with a low incidence of access-related complications. There was a trend toward better closure rates with increasing experience, suggesting a learning curve effect. Application of best practices including ultrasound guidance and angiography may ensure safe application of the technique of percutaneous large-bore axillary artery access.
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Affiliation(s)
- Ziad Al Adas
- Division of Vascular and Endovascular Therapy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Domingo Uceda
- Division of Vascular and Endovascular Therapy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Alexa Mazur
- Division of Vascular and Endovascular Therapy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Kiera Zehner
- Division of Vascular and Endovascular Therapy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Christopher J Agrusa
- Division of Vascular Surgery, New York-Presbyterian Hospital/Weill, Cornell Medical Center, New York, NY
| | - Grace Wang
- Division of Vascular and Endovascular Therapy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Darren B Schneider
- Division of Vascular and Endovascular Therapy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
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Sacha J, Krawczyk K, Gwóźdź W, Lipski P, Milejski W, Feusette P, Cisowski M, Gierlotka M. Percutaneous transaxillary approach through the first segment of the axillary artery for the Impella-supported PCI Versus TAVR. Sci Rep 2024; 14:1016. [PMID: 38200136 PMCID: PMC10781673 DOI: 10.1038/s41598-024-51552-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/06/2024] [Indexed: 01/12/2024] Open
Abstract
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.
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Affiliation(s)
- Jerzy Sacha
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Opole, Poland.
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland.
| | - Krzysztof Krawczyk
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Witold Gwóźdź
- Department of Cardiac Surgery, University Hospital, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Przemysław Lipski
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Wojciech Milejski
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Piotr Feusette
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Marek Cisowski
- Department of Cardiac Surgery, University Hospital, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Marek Gierlotka
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Opole, Poland
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Bennes O, Souteyrand G, Cambier S, Motreff P, Riocreux C, Eljezi V, Lahaye C, Eschalier R, Innorta A, Combaret N. Transfemoral versus trans-subclavian access in transcatheter aortic valve implantation using self-expandable valve: A propensity-matched comparison. Arch Cardiovasc Dis 2023; 116:555-562. [PMID: 37940389 DOI: 10.1016/j.acvd.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation is unfeasible for 10-15% of patients using the conventional transfemoral approach. Other alternative approaches, such as the subclavian approach, have emerged, with no clear recommendation indicating the superiority of one technique over another. AIM To compare the 1-month mortality and postprocedural outcomes of patients undergoing transcatheter aortic valve implantation using a self-expandable valve via transfemoral and subclavian access. METHODS This was a retrospective single-centre study including 1496 patients who underwent transcatheter aortic valve implantation between January 2016 and December 2020 at Clermont-Ferrand University Hospital, France. Propensity score matching was used to compare transfemoral and subclavian access. RESULTS After building two propensity score-matched groups of 221 patients each with either access route (total n=442), baseline characteristics were similar. The procedure duration was significantly longer in the subclavian access group (53 [45-64] versus 60 [51-72] minutes; P<0.001), but with a lower amount of contrast agent (138 [118-165] versus 123 [105-150] mL; P<0.001), fluoroscopy time (11.2 [9-14] versus 9.9 [7-12] minutes; P<0.001) and radiation dose (397 [264-620] versus 321 [217-485] mGy; P<0.001). No significant difference was observed concerning 1-month mortality (odds ratio 1.62, 95% confidence interval 0.52-5.03; P=0.39) or periprocedural complications. Follow-up at 1 year confirmed no difference in longer-term mortality (hazard ratio 0.78, 95% confidence interval 0.52-5.03; P=0.43). CONCLUSIONS The subclavian approach provides similar results to the transfemoral approach in terms of mortality, efficacy and safety; it is a reasonable and effective alternative when the reference transfemoral approach is impossible or seems complex.
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Affiliation(s)
- Olivier Bennes
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Auvergne University, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France.
| | - Géraud Souteyrand
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Auvergne University, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Sébastien Cambier
- Delegation to Clinical Research and Innovation, Biostatistics Unit, CHU Clermont-Ferrand, Clermont-Auvergne University, 63000 Clermont-Ferrand, France
| | - Pascal Motreff
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Auvergne University, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Clément Riocreux
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Auvergne University, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Vedat Eljezi
- Department of Perioperative Medicine, CHU Clermont-Ferrand, CNRS, Clermont-Auvergne University, 63000 Clermont-Ferrand, France
| | - Clément Lahaye
- Department of Geriatrics, CHU Clermont-Ferrand, CNRS, Clermont-Auvergne University, 63000 Clermont-Ferrand, France
| | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Auvergne University, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Andréa Innorta
- Department of Cardiovascular Surgery, CHU Clermont-Ferrand, CNRS, Clermont-Auvergne University, 63000 Clermont-Ferrand, France
| | - Nicolas Combaret
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Auvergne University, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France
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7
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Wittig T, Sabanov A, Schmidt A, Scheinert D, Steiner S, Branzan D. Feasibility and Safety of Percutaneous Axillary Artery Access in a Prospective Series of 100 Complex Aortic and Aortoiliac Interventions. J Clin Med 2023; 12:jcm12051959. [PMID: 36902745 PMCID: PMC10003984 DOI: 10.3390/jcm12051959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
We aimed to review the feasibility and safe use of the percutaneous axillary artery (AxA, 100 patients) approach for endovascular repair (ER) of thoraco-abdominal aortic aneurysms (TAAA, 90 patients) using fenestrated, branched, and chimney stent grafts and other complex endovascular procedures (10 patients) necessitating AxA access. Percutaneous puncture of the AxA in its third segment was performed using sheaths sized between 6 to 14F. For closing puncture sites greater than 8F, two Perclose ProGlide percutaneous vascular closure devices (PVCDs) (Abbott Vascular, Santa Clara, CA, USA) were deployed in the pre-close technique. The median maximum diameter of the AxA in the third segment was 7.27 mm (range 4.50-10.80). Device success, defined as successful hemostasis by PVCD, was reported in 92 patients (92.0%). As recently reported results in the first 40 patients suggested that adverse events, including vessel stenosis or occlusion, occurred only in cases with a diameter of the AxA < 5 mm, in all subsequent 60 cases AxA access was restricted to a vessel diameter ≥ 5 mm. In this late group, no hemodynamic impairment of the AxA occurred except in six early cases below this diameter threshold, all of which could be repaired by endovascular measures. Overall mortality at 30 days was 8%. In conclusion, percutaneous approach of the AxA in its third segment is feasible and represents a safe alternative access to open access for complex endovascular aorto-iliac procedures. Complications are rare, especially if the maximum diameter of the access vessel (AxA) is ≥5 mm.
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Affiliation(s)
- Tim Wittig
- Department of Angiology, University Hospital Leipzig, 04103 Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, 04103 Leipzig, Germany
| | - Arsen Sabanov
- Department of Vascular Surgery, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Andrej Schmidt
- Department of Angiology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Dierk Scheinert
- Department of Angiology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Sabine Steiner
- Department of Angiology, University Hospital Leipzig, 04103 Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, 04103 Leipzig, Germany
- Correspondence: ; Tel.: +49-341-9718770; Fax: +49-341-9718779
| | - Daniela Branzan
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, 04103 Leipzig, Germany
- Department of Vascular Surgery, University Hospital Leipzig, 04103 Leipzig, Germany
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Vetrovec GW, Kaki A, Wollmuth J, Dahle TG. Strategies for Reducing Vascular and Bleeding Risk for Percutaneous Left Ventricular Assist Device-supported High-risk Percutaneous Coronary Intervention. Heart Int 2022; 16:105-111. [PMID: 36741103 PMCID: PMC9872781 DOI: 10.17925/hi.2022.16.2.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/16/2022] [Indexed: 12/25/2022] Open
Abstract
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 Impella-supported 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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Affiliation(s)
- George W Vetrovec
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Amir Kaki
- Division of Cardiology, St. John’s Hospital, Wayne State University, Detroit, MI, USA
| | - Jason Wollmuth
- Providence Heart and Vascular Institute, Providence, OR, USA
| | - Thom G Dahle
- CentraCare Heart & Vascular Center, St. Cloud Hospital, St. Cloud, MN, USA
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Sugiura A, Sudo M, Al-Kassou B, Shamekhi J, Silaschi M, Wilde N, Sedaghat A, Becher UM, Weber M, Sinning JM, Grube E, Nickenig G, Charitos EI, Zimmer S. Percutaneous trans-axilla transcatheter aortic valve replacement. Heart Vessels 2022; 37:1801-1807. [PMID: 35505257 PMCID: PMC9399016 DOI: 10.1007/s00380-022-02082-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/15/2022] [Indexed: 11/26/2022]
Abstract
The left axillary artery is an attractive alternative access route for transcatheter aortic valve replacement (TAVR) and may provide better outcomes compared to other alternatives. Nevertheless, there remain concerns about vascular complications, lack of compressibility, and thorax-related complications. Between March 2019 and March 2021, 13 patients underwent transaxillary TAVR for severe aortic stenosis at the University Hospital Bonn. The puncture was performed with a puncture at the distal segment of the axillary artery through the axilla, with additional femoral access for applying a safety wire inside the axillary artery. Device success was defined according to the VARC 2 criteria. The study participants were advanced in age (77 ± 9 years old), and 54% were female, with an intermediate risk for surgery (STS risk score 4.7 ± 2.0%). The average diameter of the distal segment of the axillary artery was 5.8 ± 1.0 mm (i.e., the puncture site) and 7.6 ± 0.9 mm for the proximal axillary artery. Device success was achieved in all patients. 30-day major adverse cardiac and cerebrovascular events were 0%. With complete percutaneous management, stent-graft implantation was performed at the puncture site in 38.5% of patients. Minor bleeding was successfully managed with manual compression. Moreover, no thorax-related complications, hematomas, or nerve injuries were observed. Percutaneous trans-axilla TAVR was found to be feasible and safe. This modified approach may mitigate the risk of bleeding and serious complications in the thorax and be less invasive than surgical alternatives.
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Affiliation(s)
- Atsushi Sugiura
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Mitsumasa Sudo
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Baravan Al-Kassou
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Jasmin Shamekhi
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Miriam Silaschi
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Nihal Wilde
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Alexander Sedaghat
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Ulrich Marc Becher
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Jan-Malte Sinning
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Eberhard Grube
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Efstratios I Charitos
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
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Lichaa H. Percutaneous Axillary Artery Access for Lithoplasty of a Heavily Calcified Iliac Artery Chronic Total Occlusion. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100019. [PMID: 39132563 PMCID: PMC11307522 DOI: 10.1016/j.jscai.2022.100019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/04/2022] [Accepted: 01/09/2022] [Indexed: 08/13/2024]
Affiliation(s)
- Hady Lichaa
- Department of Cardiology, Ascension Saint Thomas Heart, Ascension Saint Thomas Rutherford Hospital, Murfreesboro, Tennessee
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11
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Seto AH, Baran DA. Percutaneous axillary access: A call to arms. Catheter Cardiovasc Interv 2021; 96:1489-1490. [PMID: 33306878 DOI: 10.1002/ccd.29408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 11/11/2022]
Abstract
The axillary artery is a useful alternative access site for large-bore interventions as it is rarely atherosclerotic. This systematic review of percutaneous large-bore axillary artery access suggests that it is as safe and effective as open surgical access. The Society of Cardiovascular Angiography and Interventions (SCAI) Expert Consensus Statement will soon be convened to provide best practice recommendations on transaxillary access including technique, training, and safety.
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Affiliation(s)
- Arnold H Seto
- Department of Medicine, Long Beach Veterans Administration Medical Center, Long Beach, California, USA
| | - David A Baran
- Division of Cardiology, Advanced Heart Failure Center, Sentara Heart Hospital, Norfolk, Virginia, USA
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Schwartz B, Jain P, Salama M, Kapur NK. The Rise of Endovascular Mechanical Circulatory Support Use for Cardiogenic Shock and High Risk Coronary Intervention: Considerations and Challenges. Expert Rev Cardiovasc Ther 2020; 19:151-164. [PMID: 33356662 DOI: 10.1080/14779072.2021.1863147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Cardiogenic shock due to acute myocardial infarction and decompensated advanced heart failure remains a source of significant morbidity and mortality. Endovascular mechanical circulatory support devices including intra-aortic balloon pump (IABP), percutaneous left ventricular assist devices (Impella and Tandemheart pumps), and veno-arterial extracorporeal oxygenation (VA-ECMO) are utilized for a broadening range of indications.Areas covered: This narrative review explores the specific devices, their distinctive hemodynamic profiles, and practical considerations. Furthermore, reviewed are the trials evaluating device outcomes which have generated significant controversy within the field of heart failure and shock. New applications and future directions are discussed.Expert opinion: Use of endovascular mechanical circulatory support has increased over the last decade, though evidence supporting their use is lacking. Development of large-scale prospective registries and clinical classification systems will facilitate patient enrollment and inform trial design. Furthermore, expansion of indications for these devices is revolutionizing how the field of heart failure and cardiogenic shock thinks about hemodynamic support. The ability to tailor therapy to a patient's specific hemodynamic profile appears to be the future of cardiogenic shock management.
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Affiliation(s)
- Benjamin Schwartz
- Department of Internal Medicine, Tufts Medical Center, Boston, MA, USATurkey
| | - Pankaj Jain
- The Cardiovascular Center, Tufts Medical Center, Boston, MA, USATurkey
| | - Michael Salama
- The Cardiovascular Center, Tufts Medical Center, Boston, MA, USATurkey
| | - Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, Boston, MA, USATurkey
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