title: Use of a Vascular Sheath in the Axillary Artery as an Alternative Access Approach for Placing an Impella 5.0 Device.
abstract: Many patients who are in cardiogenic shock need mechanical support for clinical stabilization after acute insults such as myocardial infarction. However, the placement of advanced devices can be hindered by anatomic constraints or the physiologic sequelae of shock, as we describe in this report. A 67-year-old woman with prior coronary artery bypass grafting and extensive chest-wall scarring from previous defibrillator implantations presented with myocardial infarction and refractory cardiogenic shock. The patient's vascular anatomy and prior surgery precluded conventional percutaneous implantation of an Impella 5.0 ventricular support device. We delivered the Impella device through the patient's tortuous, vasoconstricted axillary artery with use of a vascular sheath and other percutaneous techniques. The success of this approach suggests that combining the expertise of cardiologists and cardiovascular surgeons can improve the outcomes of patients with complex anatomic issues.
authors.forename: Ankur S
authors.initials: AS
authors.lastname: Shah
authors.forename: Richard
authors.initials: R
authors.lastname: Lee
authors.forename: Dawn S
authors.initials: DS
authors.lastname: Hui
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lim
authors.forename: Robert H
authors.initials: RH
authors.lastname: Neumayr
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Stolker
mesh_terms: D000368:Aged; D001366:Axillary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D002406:Catheterization, Peripheral / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D011859:Radiography; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome; D062666:Vascular Access Devices; D014654:Vascular Patency; D014661:Vasoconstriction
keywords: Angioplasty, balloon, coronary/instrumentation/methods; coronary artery disease/complications/therapy; equipment design; extremities/blood supply; heart-assist devices; knowledge bases; myocardial infarction/complications; percutaneous coronary intervention/methods; shock, cardiogenic/surgery; treatment outcome