Key result
Large bore access for the deployment of acute mechanical circulatory support devices through the axillary artery is feasible and safe when appropriate vascular access and closure techniques are used.
Why the study?
Use of acute mechanical circulatory support is growing, but alternate vascular access options remain a clinical challenge when the traditional iliofemoral route is limited.
Axillary artery access provides a feasible and safe alternative for deploying acute mechanical circulatory support devices, especially in patients with hostile iliofemoral anatomy or those requiring early ambulation.
Supports axillary access consideration for acute MCS with hostile femoral anatomy; leaves open need for prospective trials before wider adoption.
Introduction: Use of acute mechanical circulatory support (MCS) devices for high-risk cardiac intervention, cardiogenic shock, and advanced heart failure is growing. Alternate vascular access options for these devices remains a clinical challenge. Building on experience from trans-aortic valve replacement procedures, the axillary artery is becoming a common access route for acute MCS and represents an important advance in the development of acute MCS technologies.Areas covered: Authors review the clinical data and technical aspect of acute MCS deployment via the axillary artery. Axillary access is particularly useful for patients: 1) with severe peripheral vascular disease, 2) with hostile femoral access due to infection, indwelling endovascular devices, or obesity, and 3) to provide early mobility and ambulation. In this review, we discuss the deployment, technical issues and hemostasis regarding the use of intraaortic balloon pump, specifically, axillary intraaortic balloon pumps, trans-valvular left ventricular Impella pumps and arterial outflow of VA-ECMO.Expert opinion: Vascular comorbidities or device design may limit the traditional iliofemoral access route for acute mechanical circulatory support devices. Large bore access for the deployment of these devices through the axillary artery is feasible and safe when appropriate vascular access and closure techniques are used.
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Tayal et al. (2019) conducted a review in High-risk cardiac intervention, cardiogenic shock, and advanced heart failure. Acute mechanical circulatory support (MCS) deployment via the axillary artery was evaluated. Large bore access for the deployment of acute mechanical circulatory support devices through the axillary artery is feasible and safe when appropriate vascular access and closure techniques are used.
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