scholarly journals Emerging Role of Large-bore Percutaneous Axillary Vascular Access: a Step-by-step Guide

2020 ◽  
Vol 15 ◽  
Author(s):  
Kathryn Dawson ◽  
Tara L Jones ◽  
Kathleen E Kearney ◽  
James M McCabe
Keyword(s):  
Vascular Access ◽  
Mechanical Circulatory Support ◽  
Axillary Artery ◽  
Bed Rest ◽  
Arterial Disease ◽  
Circulatory Support ◽  
Femoral Access ◽  
Management Of Complications ◽  
Peripheral Arterial ◽  
Alternative Sites

Advances in transcatheter structural heart interventions and temporary mechanical circulatory support have led to increased demand for alternative sites for large-bore vascular access. Percutaneous axillary artery access is an appealing alternative to femoral access in patients with peripheral arterial disease, obesity or for prolonged haemodynamic support where patient mobilisation may be valuable. In particular, axillary access for mechanical circulatory support allows for increased mobility while using the device, facilitating physical therapy and reducing morbidity associated with prolonged bed rest. This article outlines the basic approach to percutaneous axillary vascular access, including patient selection and procedure planning, anatomic axillary artery landmarks, access techniques, sheath removal and management of complications.

scholarly journals Managing vascular access and closure for percutaneous mechanical circulatory support

2021 ◽  
Vol 23 (Supplement_A) ◽  
pp. A10-A14
Author(s):  
Konstantinos Karatolios ◽  
Patrick Hunziker ◽  
David Schibilsky
Keyword(s):  
Mechanical Circulatory Support ◽  
Axillary Artery ◽  
Vascular Complications ◽  
Vascular Trauma ◽  
Circulatory Support ◽  
Femoral Access ◽  
Arterial Access ◽  
Femoral Arterial Access ◽  
Artery Disease ◽  
Critical Aspects

Abstract Even with current generation mechanical circulatory support (MCS) devices, vascular complications are still considerable risks in MCS that influence patients’ recovery and survival. Hence, efforts are made to reduce vascular trauma and obtaining safe and adequate arterial access using state-of-the-art techniques is one of the most critical aspects for optimizing the outcomes and efficiency of percutaneous MCS. Femoral arterial access remains necessary for numerous large-bore access procedures and is most commonly used for MCS, whereas percutaneous axillary artery access is typically considered an alternative for the delivery of MCS, especially in patients with severe peripheral artery disease. This article will address the access, maintenance, closure and complication management of large-bore femoral access and concisely describe alternative access routes.

scholarly journals The impact of peripheral arterial disease on patients with mechanical circulatory support

2020 ◽  
Vol 28 ◽  
pp. 100509 ◽  
Author(s):  
Waqas Ullah ◽  
Yasar Sattar ◽  
Fahed Darmoch ◽  
Yasser Al-khadra ◽  
Tanveer Mir ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Mechanical Circulatory Support ◽  
Arterial Disease ◽  
Circulatory Support ◽  
Peripheral Arterial ◽  
The Impact

Axillary to Common Iliac Arteriovenous Graft for Hemodialysis Access: Case Report and Review of “Exotic” Axillary-Based Grafts

2005 ◽  
Vol 6 (4) ◽  
pp. 192-195 ◽  
Author(s):  
D.C. Evans ◽  
E.C. Upton ◽  
J.H. Lawson
Keyword(s):  
Peripheral Arterial Disease ◽  
Vascular Access ◽  
Axillary Artery ◽  
Arterial Disease ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Ptfe Graft ◽  
Arteriovenous Graft ◽  
Hemodialysis Access ◽  
Peripheral Arterial

A 58-year-old Caucasian male with end-stage renal disease and peripheral arterial disease was referred to us for management of his complex vascular access. His vascular access history included a left wrist primary fistula, a left upper arm access graft, a left leg loop graft, and multiple PermCaths in his jugular veins with recurrent infections. Magnetic resonance venography (MRV) of his chest revealed extensive bilateral venous occlusions due to numerous past hemodialysis access catheters. The patient was scheduled for right lower extremity arteriovenous graft placement, but intraoperatively was found to have severe peripheral arterial disease and a thromboendarterectomy was performed instead. Lower body venous imaging demonstrated patent iliac veins. Based on these anatomic considerations a right axillary artery to right common iliac vein polytetrafluoroethylene (PTFE) graft was placed. The graft required revision twice – once for graft ultrafiltration at the arterial end of the graft and once for needle stick infection – but continues to serve as sufficient access after 15 months. Grafts based off the axillary artery have become increasingly popular in recent years and several venous outflow options have been considered, each with distinct advantages. The common iliac vein offers a central location with high flow rate and low probability of infection. Axillary artery to iliac vein arteriovenous grafting may have a place in the vascular surgeon's armamentarium for complex vascular access cases.

scholarly journals Transpedal Approach in Failed Antegrade Attempt of Lower Limb Peripheral Arterial Disease—A Review with Different Treatment Strategies

2020 ◽  
Vol 29 (03) ◽  
pp. 143-148
Author(s):  
Ranjit Kumar Nath ◽  
Siva Subramaniyan ◽  
Neeraj Pandit ◽  
Deepankar Vatsa
Keyword(s):  
High Risk ◽  
Peripheral Arterial Disease ◽  
Femoral Artery ◽  
Lower Limb ◽  
Treatment Strategies ◽  
Arterial Disease ◽  
Retrograde Approach ◽  
Femoral Access ◽  
Antegrade Approach ◽  
Peripheral Arterial

AbstractTranspedal access is an evolving technique primarily used in patients after failed femoral antegrade approach to revascularize complex tibiopedal lesions. In patients who are at high risk for surgery the transpedal access may be the only option in failed antegrade femoral access to avoid amputation of the limbs. In recent years transpedal access is used routinely to revascularize supra-popliteal lesions due to more success and less complications over femoral artery approach. Retrograde approach parse will not give success in all cases and importantly success depends on techniques used. There are different techniques that need to be used depending on lesion characteristics, comorbidities, and hardware available to improve success with less complications. This review provides different strategies for successful treatment of iliac and femoral artery lesions by transpedal approach after failed antegrade femoral attempt.

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