title: Direct percutaneous access technique for transaxillary transcatheter aortic valve implantation: "the Hamburg Sankt Georg approach".
abstract: OBJECTIVE
  This study questioned whether transaxillary transcatheter aortic valve implantation (TAVI) is feasible as a true percutaneous approach using percutaneous closure devices.
  
  
  BACKGROUND
  Transaxillary TAVI is gaining increasing acceptance as an alternative to the transfemoral route; however, the access has always been done via surgical cutdown so far.
  
  
  METHODS
  Between August 2010 and September 2011, a total of 24 high-risk patients with severe aortic valvular stenosis underwent a percutaneous TAVI procedure by direct puncture of the axillary artery without surgical cutdown. For safety reasons and as a target for the puncture, a wire was advanced via the ipsilateral brachial artery. Moreover, a balloon was placed into the subclavian artery via the femoral artery for temporary vessel blockade before percutaneous vessel closure. Vascular closure was performed using either the ProStar XL system (Abbott Vascular Devices, Redwood City, California) or 2 ProGlide systems (Abbott Vascular Devices).
  
  
  RESULTS
  The true percutaneous approach was successfully completed in all patients (14 left and 8 right axillary artery cases). Overall mortality at 30 days was 8.3%. Acute vascular closure device success was achieved in 17 patients (71%). Vascular closure device success rate was 100% for the ProGlide device and 37% for the ProStar device, respectively. Seven patients (29%) with failing closure devices were treated by endovascular stent graft implantation without the need for surgical repair. For the last 12 treated patients, direct closure was achieved in 11 patients.
  
  
  CONCLUSIONS
  Direct puncture of the axillary artery for TAVI is feasible and safe if a wire is placed into the subclavian artery via the ipsilateral brachial artery.
authors.affiliation: Department of Cardiology, Asklepios Clinics Sankt Georg, Hamburg, Germany. Electronic address: ul.schaefer@asklepios.com.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schäfer
authors.affiliation: National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, United Kingdom.
authors.forename: Yen
authors.initials: Y
authors.lastname: Ho
authors.affiliation: Department of Cardiology, Asklepios Clinics Sankt Georg, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Frerker
authors.affiliation: Department of Cardiology, Asklepios Clinics Sankt Georg, Hamburg, Germany.
authors.forename: Dimitry
authors.initials: D
authors.lastname: Schewel
authors.affiliation: Faculty of Medicine, Department of Anatomy and Cell Biology, Badajoz, Spain.
authors.forename: Damian
authors.initials: D
authors.lastname: Sanchez-Quintana
authors.affiliation: Medical Care Center Prof. Mathey, Prof. Schofer; Hamburg University Cardiovascular Center, Hamburg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Schofer
authors.affiliation: Medical Care Center Prof. Mathey, Prof. Schofer; Hamburg University Cardiovascular Center, Hamburg, Germany.
authors.forename: Klaudija
authors.initials: K
authors.lastname: Bijuklic
authors.affiliation: Department of Cardiology, Asklepios Clinics Sankt Georg, Hamburg, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Meincke
authors.affiliation: Department of Cardiology, Asklepios Clinics Sankt Georg, Hamburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Thielsen
authors.affiliation: Department of Cardiology, Asklepios Clinics Sankt Georg, Hamburg, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Kreidel
authors.affiliation: Department of Cardiology, Asklepios Clinics Sankt Georg, Hamburg, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D001366:Axillary Artery / Q000000981:diagnostic imaging; D021721:Balloon Occlusion; D019917:Blood Vessel Prosthesis Implantation; D001916:Brachial Artery / Q000000981:diagnostic imaging; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D057510:Endovascular Procedures; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D005858:Germany; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006489:Hemostatic Techniques / Q000295:instrumentation; D006801:Humans; D008297:Male; D011677:Punctures; D015641:Radiography, Interventional; D012720:Severity of Illness Index; D013348:Subclavian Artery / Q000000981:diagnostic imaging; D013997:Time Factors; D016896:Treatment Outcome