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Safe Large Bore Percutaneous Axillary Access
Ciaran Sualdam O'Brien, MD, Lama Obeid, MD, Jasmine Bhinder, MD, Ziad Al Adas, MD, Darren B. Schneider, MD.
University of Pennsylvania, Philadelphia, PA, USA.
This video presentation depicts a technique for safe, large bore, percutaneous axillary access. This technique is an invaluable adjunct to femoral access for completion of branched and fenestrated aortic endografts. Positioning, anatomy and sonographic appearance of the 2
nd portion axillary artery are reviewed, and a shallow needle angle technique is demonstrated. Placement of proglides is demonstrated with manual pressure to compress the artery against the 2
nd rib during exchanges. Next the technique for introducing the large bore sheath over a through wire is demonstrated. The second portion of the video reviews the technique for safe closure of the arteriotomy. The video shows and describes a technique for maintaining wire access through the axillary arteriotomy as well as sheath and wire access to the axillary artery via a femoral sheath. This allows for evaluation of hemostasis with angiography, and rescue maneuvers such as occlusion balloon or covered stent placement in the event of failure to obtain hemostasis. The video concludes with a review of the key learning points to enable safe large bore percutaneous axillary access and closure. Viewers of the video will leave with several concrete ways to improve their percutaneous axillary access technique.
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