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).
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.
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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.
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