Axillary Artery Percutaneous Access for Endovascular Interventions
Emily Harris, BS, Courtney J. Warner, MD, Jeffrey C. Hnath, MD, Yaron Sternbach, MD, R. Clement Darling, III, MD.
Albany Medical College, Albany, NY, USA.
INTRODUCTION: As endovascular therapy becomes increasingly complex, adjunct techniques such as upper extremity arterial access facilitate visceral branch interventions. The purpose of this study is to assess the viability of axillary artery percutaneous access in endovascular repair.
METHODS: Records of all patients undergoing axillary artery percutaneous access as part of an endovascular intervention from December 2015-July 2016 were examined. Patient demographics (age, sex, medical co-morbidities, smoking status, and anticoagulation) were documented. Each case was examined for technical success and perioperative complications including hematoma, brachial plexus injury, and return to OR. Early functional outcomes were assessed using clinic follow-up documentation.
RESULTS: Over the study interval, 201 TEVAR and EVAR were performed; 23 axillary artery punctures in a total of 17 patients were performed for endovascular intervention. The mean age was 72 years, most patients were male (76.5%), and the cohort had a typical vascular comorbidity profile (hypertension in 88%, hyperlipidemia in 88%, 24% diabetic, 59% with CAD, 47% COPD, 88% active or former smoker). Axillary access was obtained as part of juxtarenal aortic aneurysm repair in 16 patients and superior mesenteric artery access for lysis in 3 patients. Sheath size was most frequently 6F (6 punctures) or 7F (14 punctures). Closure devices were approximately half Perclose (39%) and half Angio-seal (61%). Freedom from re-intervention was 100%, with no incidences of return to the OR for revascularization or access complications (occlusion/thrombosis, pseudoaneurysm, hematoma, severe brachial plexus injury). There was no perioperative stroke or death. One patient had transient ipsilateral postoperative thumb numbness, and one patient had residual bleeding after closure requiring manual pressure.
CONCLUSIONS: Axillary artery percutaneous access is a viable strategy to facilitate complex endovascular interventions. This technique avoids the need for brachial artery exposure and allows for larger sheath sizes due to the larger caliber of the axillary artery. There was 100% technical success with no bleeding or ischemic complications. This technique is a safe and practical alternative to approaches involving exclusively femoral and brachial access.
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