Insertion of the Impella via the axillary artery for high-risk percutaneous coronary intervention

• Published in: Cardiovascular revascularization medicine Vol. 19; no. 5; pp. 540 - 544
• Main Authors: Truong, Huu Tam D., Hunter, Glenn, Lotun, Kapildeo, Shetty, Ranjith, Shanmugasundaram, Madhan, Kapoor, Divya, Thai, Hoang M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2018
• Subjects: Axillary artery; Coronary artery disease; Impella; Percutaneous coronary intervention; LCx; NSTEMI; NYHA; AAA; SVG; LVEF; Impella; Percutaneous coronary intervention; Coronary artery disease; LAD; Axillary artery; RCA; PAD; LIMA; STS; PCI; STEMI; COPD
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2017.12.016

Hemodynamic support with the Impella device is an important tool during high risk percutaneous coronary intervention. This device is usually inserted via the femoral artery. However, some patients have severe peripheral artery disease precluding the use of the femoral artery for this purpose. The axillary artery is a viable alternative in these cases. We reviewed the two access techniques for inserting the Impella via the axillary artery and also described 6 cases of successful implantation.
•The axillary artery is a good alternative for Impella insertion in patients without optimal femoral access.•Axillary access has potential advantages of early mobilization and lower risk of infection.•The cutdown approach offers hemostasis by direct closure, minimizing serious complications due to bleeding.•The percutaneous approach is less invasive and can be performed under moderate sedation.