Axillary Access for Microaxial Ventricular Support Device Placement

There is little evidence in support of the axillary access for counterpulsation balloon insertion, but this evidence is null when it comes to microaxial ventricular support device placement (the Impella device family). 

Acceso percutáneo axilar para dispositivos de asistencia ventricular

Clinical indication of short-term mechanical circulatory support devices has been on the rise. Many patients present suboptimal iliofemoral access or early mobilization is required. 

Axillary artery access is an option for these patients, and this is the rationale behind the ARMS Registry (Axillary Access Registry to Monitor Safety) which prospectively included patients to analyze the feasibility and safety of this procedure. 

A total 102 patients from 10 centers were included. Successful device implantation was 98% and support lasted mean 2 days (range 0-35 days). Postprocedural access site hematoma or bleeding was noted in 9 patients. 

Major complications included 10 bleedings and one stroke. Minor complications included 3 patients presenting, after several days, C8 tingling consistent with brachial plexus related symptoms. 


Read also: Intravascular Imaging: A Universal Approach for Angioplasty Optimization.


Device explantation was done with closure devices alone in 61% of cases, stent grafts in 17%, balloon tamponade facilitated closure in 15%, and planned surgical explant in 5%. 

Support duration was independently associated with vascular complications and increased complications by 1.1% per day.

Conclusion

Percutaneous axillary access of microaxial support pumps (Impella family) appears feasible with acceptable rates of bleeding, despite the early experience.

Original Title: Percutaneous Axillary Access for Placement of Microaxial Ventricular Support Devices. The Axillary Access Registry to Monitor Safety (ARMS).

Reference: James M. McCabe et al. Circ Cardiovasc Interv. 2021;14:e009657. DOI: 10.1161/CIRCINTERVENTIONS.120.009657.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 – ECLIPSE: Randomized Study of Orbital Atherectomy vs Conventional PCI in Severely Calcified Lesions

Coronary calcification is associated with stent under-expansion and increased risk of both early and late adverse events. Atherectomy is an essential tool for uncrossable...

TCT 2024 | Use of Drug-Coated Balloons for Side Branch Treatment in Provisional Stenting

In some cases, treating coronary bifurcations with provisional stenting requires side branch stenting, which may lead to suboptimal outcomes. Drug-coated balloons (DCBs) have emerged...

TCT 2024 | Use of Artificial Intelligence for Patients with Suspected Coronary Artery Disease

The current approach to chest pain mainly focuses on symptom characteristics, conducting functional tests for ischemia assessment. However, several randomized clinical trials have shown...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...