title: Totally Percutaneous Insertion and Removal of Impella Device Using Axillary Artery in the Setting of Advanced Peripheral Artery Disease.
abstract: Traditionally, brachial and common femoral arteries have served as access sites of choice, with many operators recently converting to radial artery access for coronary angiography and percutaneous intervention due to literature suggesting reduced bleeding risk, better patient outcomes, and lower hospital-associated costs. However, radial access has limitations when percutaneous procedures requiring larger sheath sizes are performed. Six Fr sheaths are considered the limit for safe use with the radial artery given that the typical luminal diameter of the vessel is approximately 2 mm, while peripheral artery disease (PAD) may often limit use of the common femoral artery, particularly in patients with multiple co-morbid risk factors. Similarly, the brachial artery has fallen out of favor due to both thrombotic and bleeding risks, while also not safely and reliably accommodating sheaths larger than 7 Fr. Here we describe 3 cases of a new entirely percutaneous technique utilizing the axillary artery for delivery of Impella 2.5 (13.5 Fr) and CP (14 Fr) cardiac-assist devices for protected percutaneous coronary intervention in the setting of prohibitive PAD.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Tayal
authors.forename: Mihir
authors.initials: M
authors.lastname: Barvalia
authors.forename: Zeshan
authors.initials: Z
authors.lastname: Rana
authors.forename: Benjamin
authors.initials: B
authors.lastname: LeSar
authors.forename: Humayun
authors.initials: H
authors.lastname: Iftikhar
authors.forename: Spas
authors.initials: S
authors.lastname: Kotev
authors.forename: Marc
authors.initials: M
authors.lastname: Cohen
authors.affiliation: Department of Cardiology C2, Newark Beth Israel Medical Center, 201 Lyons Avenue at Osborne Terrace, Newark, NJ 07112 USA. nwasty@barnabashealth.org.
authors.forename: Najam
authors.initials: N
authors.lastname: Wasty
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001366:Axillary Artery; D006328:Cardiac Catheterization / Q000379:methods; D062906:Cardiac Catheters; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D020878:Device Removal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D058729:Peripheral Arterial Disease / Q000150:complications*; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents