title: Transcatheter aortic valve implantation through distal axillary artery: novel option for vascular access.
abstract: OBJECTIVE
  We describe an alternative access approach for patients undergoing transcatheter aortic valve implantation (TAVI) using surgical cut down of the distal axillary artery, in cases wherein transfemoral access is not feasible.
  
  
  METHODS
  From January 2012 to July 2013, 61 patients (59% men; mean age 81 ± 8 years) underwent TAVI at our institution. The mean logistic EuroSCORE and EuroSCORE II were 36 ± 24 and 14 ± 10, respectively. We assessed device success, 30-day safety and clinical efficacy using VARC II criteria.
  
  
  RESULTS
  TAVI was performed with the CoreValve Revalving System (CRS) (Medtronic Inc., Minneapolis, Minnesota, USA) in all cases, using transfemoral approach in 57 patients and distal trans-axillary route in four patients. A device was successfully implanted in 94%, without any major intraprocedural complications. One case of acute kidney disease, four cases of minor vascular complication and two cases of life-threatening bleeding occurred after the procedure for pericardial bleeding requiring pericardiocentesis. Permanent pacemaker was implanted in 26% of patients. There was no instance of in-hospital mortality, while two deaths (3%) occurred in the first 30 days. The total procedure time (skin-to-skin) was longer in the trans-axillary group secondary to surgical management of access site (P = 0.027), whereas revalving and fluoroscopy time were similar (P = 0.95 and P = 0.83, respectively).
  
  
  CONCLUSIONS
  The location and anatomical relations of the distal axillary artery make it a safer, reproducible and operator friendly access option for TAVI.
authors.affiliation: aDepartment of Cardiovascular Disease bDepartment of Vascular Surgery cDepartment of Anaesthesiology, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Ussia
authors.forename: Valeria
authors.initials: V
authors.lastname: Cammalleri
authors.forename: Andrea Ascoli
authors.initials: AA
authors.lastname: Marchetti
authors.forename: Kunal
authors.initials: K
authors.lastname: Sarkar
authors.forename: Pasquale
authors.initials: P
authors.lastname: De Vico
authors.forename: Saverio
authors.initials: S
authors.lastname: Muscoli
authors.forename: Domenico
authors.initials: D
authors.lastname: Sergi
authors.forename: Massimo
authors.initials: M
authors.lastname: Marchei
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Ippoliti
authors.forename: Francesco
authors.initials: F
authors.lastname: Romeo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001366:Axillary Artery; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome