SCAI Position Statement on Best Practices for Percutaneous Axillary Arterial Access and Training

Figure 1. Axillary artery and surrounding structures including vessels, bones, nerve and muscle. The 3 segments of the axillary artery are marked relative to the pectoralis minor muscle.

Figure 2. Upper row: Representative cross-sectional left axillary ultrasound images at the first segment (left), second segment (center) and third segment (right) demonstrating the relationship between the pectoralis muscles (Pec), axillary vein (V), and axillary artery (A). Lower panel: Ultrasound probe with (inset) color Doppler ultrasound image showing a nerve anterior to third axillary artery segment.

Figure 3. Angiographic anatomy of the axillary artery with branches.

Figure 4. Dry closure of the axillary artery, using a balloon inserted from the femoral artery and inflated in the subclavian artery before removal of the axillary sheath.

Figure 5. Manual pressure of the axillary artery (arrow) around the second rib with nonocclusive hemostasis confirmed by angiography.

Figure 6. Covered stent use for bleeding. A) Bleeding at axillary puncture site B) balloon inflation across the puncture site C) Stent graft bailout. D) Extravasation at axillary artery puncture site after Perclose closure failure. Angiogram performed while testing closure. Note maintenance of wire access at axillary puncture site and safety wire across axillary artery E) Hemostasis after deployment of self-expanding Viabahn (W.L. Gore) covered stent F) CTA at 1-month follow-up showing patent axillary artery covered stent.

Figure 7. Dissection. A) Angiography showing extensive dissection and thrombosis of the left subclavian artery. B) After extensive thrombectomy, angioplasty and stenting of the left subclavian and axillary artery. Note thrombus shift into the vertebral and left internal mammary artery which was asymptomatic C) Distal embolization to the left radial, ulnar and interosseous arteries D) Restoration of flow to all 3 forearm arteries after aspiration thrombectomy and low-pressure balloon angioplasty.