Axillary Artery Access Research Articles

Axillary artery access considerations in Impella 5.5insertion: Insights from exclusive axillary approach forsuccessful support.

The Impella 5.5® is commonly inserted via the axillary artery (AX) in patients with cardiogenic shock. The right AX has traditionally been preferred to avoid crossing the aortic arch, and a minimum diameter of 7 mm has been recommended to accommodate the device (21 Fr). There is limited data on choice of laterality of access and AX size required, both in terms of technicality of the procedure as well as outcomes. We performed a single-center retrospective cohort analysis of patients who underwent Impella 5.5® implantation between December 2020 and February 2024 (N = 75). Data including demographics and outcomes were stratified both by diameter (small, <7 mm vs. normal, ≥7 mm) and laterality of access (right vs. left). Adverse events included stroke, limb ischemia, procedural bleeding or infection, and unplanned explant due to complications. Delivery time was defined as time from advancing the first wire to activation of the device. AX approach was attempted in all (N = 74) but one requiring innominate access, with a technical success rate of 95.9% (N = 71/74). The mean age was 58.8 ± 13.3 years, with 81.1% males. The median delivery time was 7.0 (25th, 75th percentiles: 4.0, 11.5) min with a median support duration of 13 (7.7, 24) days. Ten patients (13.5%) had a small AX, with a mean diameter of 6.3 ± 0.5 mm and were more likely to be younger compared to the normal AX group. Fifty-nine patients (79.7%) had insertion via the right AX. Median delivery time was comparable across all groups (small, 5.4 [3.5, 10.9] vs. normal, 7 [4.0, 12.1] min, p = 0.59) and (right, 10.4 [5.3, 15.2] vs. left, 6 [3.7, 10.4] min, p = 0.35). There was no difference between the rates of stroke, ischemia, bleeding, or infection when comparing by size or laterality. Survival to discharge was 59.5%, with 21.1% mortality on support, all in patients with a normal AX diameter, but with no difference between right versus left. In our study, laterality and a small diameter of AX access did not affect outcomes of Impella 5.5®, with a similar safety profile.

The Impact of Ipsilateral Implantable Cardioverter Defibrillator in Axillary Intra-Aortic Balloon Pump Support as Bridge to Heart Transplantation.

The axillary artery (AX) access for intra-aortic balloon pump (IABP) as a bridge to heart transplant (HT) allows mobility while awaiting a suitable donor. As end-stage heart failure patients often have an implantable cardioverter defibrillator (ICD) on the left side, the left AX approach may be avoided due to the perception of difficult access and proximity of two devices. We aimed to evaluate the outcomes of patients bridged to HT with a left-sided AX IABP with or without ipsilateral ICDs. We retrospectively reviewed HT candidates at our institution supported by left-sided axillary IABP from November 2019 to February 2024, dividing them into two groups based on the presence (Group ICD, n = 48) or absence (Group No-ICD, N = 19) of an ipsilateral left-sided ICD. The exposure time was defined as the time from skin incision to the beginning of anastomoses of a Dacron graft. Technical success was achieved in 100% of the cohort, with median exposure times for AX access similar between groups (ICD, 12 [7.8, 18.2] vs. No ICD, 11 [7, 19] min; p = 0.75). The rate of procedural adverse events, such as significant access site bleeding and ipsilateral limb ischemia, did not significantly differ between both groups. Device malfunction rates were comparable (ICD, 29.2%vs. No ICD, 15.8%; p = 0.35). Posttransplant, in-hospital mortality, severe primary graft dysfunction, and stroke rates were comparable in both groups. The presence of an ipsilateral left-sided ICD does not adversely impact the procedural efficacy, complication rates, or posttransplant outcomes of left-sided AX IABP insertion in HT candidates.

Safety and learning curve of percutaneous axillary artery access for complex endovascular aortic procedures: Presented at the plenary session of the 2022 Vascular Annual Meeting of the Society for Vascular Surgery, Boston, Massachusetts, June 15-18, 2022.

Safety and learning curve of percutaneous axillary artery access for complex endovascular aortic procedures: Presented at the plenary session of the 2022 Vascular Annual Meeting of the Society for Vascular Surgery, Boston, Massachusetts, June 15-18, 2022.

Incidence, risk factors, and management following cardiac catheterization via carotid and axillary artery approaches: A single-center experience on pseudoaneurysms in young infants.

Use of alternate access for complex neonatal interventions has gained acceptance with carotid and axillary artery access being used for ductal and aortic interventions. This study was a retrospective, single-center study at Cincinnati Children's Hospital Medical Center. The study included infants, aged ≤90 days, who underwent cardiac catheterization with either carotid or axillary artery access between 2013 and 2022. Data encompassing demographics, clinical information, catheterization data, and the incidence of pseudoaneurysm as a procedural complication were collected. Among 29 young infants (20 males, 69%), 4 out of 15 patients (27%) who underwent the carotid approach developed pseudoaneurysms, while 1 out of 14 patients (7.1%) who underwent the axillary approach developed one. Two patients required transcatheter intervention due to enlargement of pseudoaneurysms, involving the placement of transarterial flow-diverting stent and occlusion of left common carotid artery. Longer sheath in-to-out time (135 vs. 77 min, p = 0.001), and higher closing activated clotting times (ACT) (268 vs. 197 s, p = 0.021) were observed among patients with pseudoaneurysms compared to those without. Young infants with alternative access via the carotid and axillary arteries may be at risk of pseudoaneurysm formation during longer procedures and with higher ACTs for closure. Ultrasound-guided compression can be employed to prevent the progression and in resolution of these lesions.

Systematic approach to obtain axillary arterial access for pediatric heart catheterizations.

Axillary arterial access (AAA) in pediatric heart catheterizations is undervalued. We retrospectively reviewed children with congenital heart diseases (CHDs) who received trans-axillary arterial catheterizations between January 2019 and February 2023. We aimed ultrasound-guided punctures in the proximal two-thirds of axillary arteries with diameters ≥2 mm to insert 7 cm/4 Fr short introducers. We administrated intra-arterial verapamil (1.25 mg) and heparin (100 UI/kg). We infiltrated per-operatively 2% lignocaine (10 mg) for arterial spasms, long sheaths use (≥5 Fr), and ≥60 min procedures in <3 kg patients. We identified 30 patients (66.7% males) with a median age of 1.1 months (IQR, 0.3-5.4), and a median weight of 3.1 kg (IQR, 2.7-3.7). 5/30 patients had six redo interventions after a median of 3.9 months (IQR, 1.7-5.1). Overall, 27/36 procedures were interventional, including 6 aortic valvuloplasties, 6 balloon angioplasties, and 15 stenting procedures. The median arterial axillary angiographic diameter was 2.6 mm (IQR, 2.4-3). Access was right-sided in 23/36 (63.9%) procedures and obtained using 21G/2.5 cm bevel needles in 25/36 (69.4%) procedures. No hemodynamical change occurred after introducing spasmolytic drugs. The median fluoroscopy time was 26.1 min (IQR, 19.2-34.8). There were two self-resolving arterial dissections, one sub-occlusive arterial thrombosis (resolved with 6 weeks of enoxaparin), and one occlusive arterial thrombosis (resolved with alteplase thrombolysis and 6 weeks of enoxaparin). Median follow-up was 11.7 months (IQR, 8-17.5). Four patients with complex univentricular hearts died from non-procedural causes at a median of 40 days (IQR, 31-161) postoperative. Systematic approach for AAA is the key to success and unlocks the many potentials of trans-axillary pediatric cardiology interventions.

Safety and learning curve of percutaneous axillary artery access for complex endovascular aortic procedures

BackgroundPercutaneous axillary artery access is increasingly used for large-bore access during interventional vascular and cardiac procedures. The aim of this study was to evaluate the safety and learning curve of percutaneous axillary artery access in patients undergoing complex endovascular aortic repair (fenestrated and branched endovascular aneurysm repair [FBEVAR]) requiring large-bore upper extremity access and to discuss best practices for technique and complication management. MethodsOne-hundred forty-six patients undergoing large-bore percutaneous axillary artery access during FBEVAR in a prospective, nonrandomized, Investigational Device Exemption study between September 2017 and January 2023 were analyzed. Ultrasound guidance and micropuncture were used to access the second portion of the axillary artery and 2 Perclose Proglide or Prostyle devices (Abbott Vascular) were predeployed before the insertion of the large-bore sheath. Completion angiography was performed in all patients to verify hemostatic closure. Axillary artery patency was also assessed on follow-up computed tomography angiography. Patient-related, procedural, and postoperative variables were collected and analyzed. ResultsOne-hundred forty-five patients underwent successful percutaneous axillary artery access; 1 patient failed axillary access and alternative access was established. The left axillary artery was accessed in 115 patients (79%), and the right axillary artery was accessed in 30 patients (21%). The largest profile sheath was 14 F in 4 patients (2.8%), 12F in 133 patients (91.7%), and 8F in 8 patients (5.5%). Ten patients (6.9%) required covered stent placement (Viabahn, W. L. Gore & Associates) for failure to achieve hemostasis; there were no conversions to open surgical repair. Additional adverse events included transient upper extremity weakness in two patients (1.3%) and transient upper extremity paresthesias in two patients (1.3%). Three patients (2%) suffered postoperative strokes, including one unrelated hemorrhagic stroke and two possibly access-related embolic strokes. On follow-up, axillary artery patency was 100%. There was a trend toward decreased closure failure over time, with seven patients (10%) in the early cohort and three (4%) in the late cohort. There was a significant negative correlation between the cumulative complication rate and the cumulative experience. ConclusionsLarge-bore percutaneous axillary artery access provides safe upper extremity large-bore access during FBEVAR, achieving successful closure in >90% of patients with a low incidence of access-related complications. There was a trend toward better closure rates with increasing experience, suggesting a learning curve effect. Application of best practices including ultrasound guidance and angiography may ensure safe application of the technique of percutaneous large-bore axillary artery access.

P56: The Impact of Ipsilateral Implantable Cardioverter Defibrillator in Axillary Intra-Aortic Balloon Pump Support as Bridge-to-Heart Transplantation

Background: The axillary artery (AX) access for intra-aortic balloon pump (IABP) as a bridge to heart transplant (HT) allows mobility while awaiting a suitable donor. As end-stage heart failure patients often have an implantable cardioverter defibrillator (ICD) on the left side, the left AX approach may be avoided due to the perception of difficult access and proximity of two devices. Purpose: We compare the outcomes of patients undergoing HT that were bridged with a left-sided AX IABP with or without ipsilateral ICDs. Methods: Patients who had undergone left AX IABP as a bridge to HT between January 2010 to February 2022 were retrospectively reviewed (N=31). All AX IABPs were surgically implanted via the left AX. ICD was present in a total of 17 (80.9%) on the left side (Group ICD) while 14 patients did not have ICD on the left side (Group No-ICD). The procedural time was defined as the time from skin incision to the beginning of anastomoses of a Dacron graft. Results: The median age of the recipients was 55.6±12.9 with 80.6% (N=25) males. The median duration of left AX IABP support was 14 (8,22) days. Technical success was 100%. The mean procedure time to expose the AX was comparable between the two groups (ICD, 12.5±6.2 min vs. No-ICD, 11.2±6.0 min, P=0.640), as was the incidence of bleeding/hematoma (ICD, 0% vs. No-ICD, 7.1%, P=0.202). There was no ischemic stroke in both group. The most common adverse event in the cohort was a malfunction in 4 patients (12.9%) and malposition requiring exchange in 2 patients (6.4%). There was AX hematoma in 1 patient requiring revision and 1 patient with a right-sided ICD who had peripheral vascular disease developed left-sided arm and lower limb ischemia. Neither group had no device-related infection, wound infection, or brachial plexus symptoms. Conclusion: The insertion of IABP via the left AX as a bridge to HT is feasible with a good safety profile. The left AX approach for patients with ipsilateral ICDs can also be performed safely without increasing procedure time and adverse events.

CARC8: Right versus Left Axillary Artery Access in Impella 5.5 Insertion

Background: The Impella 5.5® is commonly inserted via the axillary artery (AX) in patients with cardiogenic shock. Insertion of Impella through the left AX requires crossing the aortic arch, and possibly a divergent angle of insertion through the aortic valve. However, there is limited data on comparison of choice of laterality of access, both in terms of technicality of the procedure as well as outcomes on device support. Methods: We performed a single-center retrospective cohort analysis of patients who underwent Impella 5.5® implantation between December 2020 and November 2022 (N=28). Data including demographics and outcomes were stratified by laterality of AX access. Adverse events included stroke, ipsilateral upper extremity ischemia, bleeding related to vascular access, infection related to Impella use, and unplanned explant due to complications. Delivery time was defined as time from advancing the first wire to activation of the device. Results: Twenty patients had insertion via the right axillary artery and 8 patients had access through the left side. Average duration of support was comparable (right, 9.8 + 5.3 vs. left, 10.2 + 6.6 days, p=0.83). The median delivery time was lower through right side compared to left sided access (7.9 + 3.6 vs. 12.4 + 6.9 minutes, p=0.048). Overall survival to discharge was 64.3%, with a 21.4% mortality while on support, but there was no difference between groups. Explant rate was similar in both groups (right, 80% vs. left, 75%, p=0.77). Overall adverse event rate was 3.5%, with surgical evacuation of implantation site hematoma in 1 patient with left sided access. There was no difference between the rates of suction events, hemolysis, repositioning or removal required when comparing right versus left. Neither group had patients with stroke, arm ischemia, or infection. Conclusion: Overall, Impella 5.5 support via the AX demonstrated favorable outcomes regarding a low incidence of adverse events and stable support with a high explant rate. In our study, the choice of laterality of AX access for Impella insertion did not affect outcomes, with a similar safety profile. Access through the right AX may be preferable due to shorter delivery time in the absence of contraindications.

P298 TRANS–AXILLARY ACCESS AS AN ALTERNATIVE ROUTE IN TRANSCATHETER AORTIC VALVE IMPLANTATION

Abstract Background Transcatheter aortic valve replacement (TAVR) is the main procedure for treating severe aortic stenosis in patients considered at high surgical risk. Generally, this procedure is performed through percutaneous femoral arterial access. The presence of anatomical variants or peripheral atherosclerotic pathology sometimes necessitates the use of alternative vascular accesses, including access through the axillary artery. Data from a meta–analysis involving 1793 patients who underwent TAVR through trans axillary or transapical access showed a statistically significant reduction in 30–day mortality in the former group. We wait for future randomized trials to confirm the consistency of these data. Clinical case 71–year–old man, smoker, hypertensive and dyslipidaemic. In 2018, he underwent bilateral aorta–iliac–femoral bypass surgery for severe lower limb arteriopathy. Due to the onset of angina and dyspnea at rest, he went to the ER where a diagnosis of NSTEMI was made. On echocardiogram, there was evidence of severe high–gradient aortic stenosis while coronary angiography showed 80% RCA stenosis in the middle tract. Because of the high surgical risk (EUROSCORE II: 12%) and the evidence of bilateral femoral artery occlusion on CT–angiography, the Heart Team concluded to perform TAVR through percutaneous left trans–axillary access with concomitant percutaneous coronary revascularization. Obtained the backup access on the left radial artery, PTCA+DES was performed on RCA through the right radial access with subsequent placement of a pigtail catheter in the non–coronary sinus of Valsalva. Once the temporary pacemaker had been placed through the right femoral vein, an angio–guided puncture of the left axillary artery was performed with placement of the 14 Fr introducer for implantation of the Medtronic Evolut R 26 mm aortic biological prosthesis. Post–procedure ultrasound examination showed a residual mean aortic valve gradient of 17 mmHg with evidence of a small periprosthetic leak. Seven days after the procedure, the patient was discharged, asymptomatic and in good hemodynamic compensation without vascular complications. Conclusions Trans–axillary arterial access should be considered a viable alternative to transfemoral access for the performance of TAVR.

Feasibility and Safety of Percutaneous Axillary Artery Access in a Prospective Series of 100 Complex Aortic and Aortoiliac Interventions

We aimed to review the feasibility and safe use of the percutaneous axillary artery (AxA, 100 patients) approach for endovascular repair (ER) of thoraco-abdominal aortic aneurysms (TAAA, 90 patients) using fenestrated, branched, and chimney stent grafts and other complex endovascular procedures (10 patients) necessitating AxA access. Percutaneous puncture of the AxA in its third segment was performed using sheaths sized between 6 to 14F. For closing puncture sites greater than 8F, two Perclose ProGlide percutaneous vascular closure devices (PVCDs) (Abbott Vascular, Santa Clara, CA, USA) were deployed in the pre-close technique. The median maximum diameter of the AxA in the third segment was 7.27 mm (range 4.50-10.80). Device success, defined as successful hemostasis by PVCD, was reported in 92 patients (92.0%). As recently reported results in the first 40 patients suggested that adverse events, including vessel stenosis or occlusion, occurred only in cases with a diameter of the AxA < 5 mm, in all subsequent 60 cases AxA access was restricted to a vessel diameter ≥ 5 mm. In this late group, no hemodynamic impairment of the AxA occurred except in six early cases below this diameter threshold, all of which could be repaired by endovascular measures. Overall mortality at 30 days was 8%. In conclusion, percutaneous approach of the AxA in its third segment is feasible and represents a safe alternative access to open access for complex endovascular aorto-iliac procedures. Complications are rare, especially if the maximum diameter of the access vessel (AxA) is ≥5 mm.

Percutaneous Axillary Artery Puncture: An Efficient Approach for Upper Extremity Access

The aim was to analyze the anatomic feasibility of the percutaneous axillary access (PAXA) using cadaverous models and then to analyze the complications associated with PAXA during Fenestrated or Branched Endovascular Aneurysm Repair (F/BEVAR) procedures. Cadaverous models were used to analyze axillary pedicle after a PAXA on an initial anatomical investigation. A subclavian approach was performed after puncture to assess the injuries caused by the needle. Then, in an observational study, patients who underwent F/BEVAR using a PAXA between July 2019 and July 2021 were included. PAXA-related events and complications were monitored. Eleven dissections were performed on cadavers. The axillary vein was injured twice (18.2%); the puncture site on the axillary artery was found on the arterial proximal part, behind the clavicle. Fifty-three patients underwent a F/BEVAR using a PAXA. The mean (SD) age of patients was 74.5 (9.7) years. Most indications for endovascular repair were para-renal aneurysms (66%). Two Proglide® closure devices served to close arterial access in all procedures. Adjunct balloon inflation was used in 19 (35.8%) patients. There were 5 (9.4%) PAXA-related events included preoperative blush in 2 (3.8%) patients, axillary artery dissection in 2 (3.8%), and 1 (1.9%) axillary artery stenosis. Five patients (9.4%) had a postoperative axillary hematoma without need for additional surgical procedure. No PAXA-related complication was found after discharge (mean [SD] 11.7 [7.4] months following surgery). Percutaneous axillary artery access was an efficient upper extremity access and associated with a low rate of PAXA-related events.

Midterm Results of a Surgeon-Modified Device to Preserve the Flow of the Internal Iliac Artery During Endovascular Repair of Aneurysm: Single-Center Experiences

During endovascular aneurysm repair (EVAR), commercial iliac branch devices (IBDs) have become an inescapable alternative for preserving antegrade internal iliac artery (IIA) blood flow. Due to the different morphological features of aneurysms, commercial IBDs may not be suitable for all patients. Reported experience with the implantation of the new surgeon-modified IBD (sm IBD) is limited. This investigation describes the indications, efficacy, and safety of the sm IBD. Data from consecutive elective implantations of IBDs in patients between March 2011 and May 2021 in a single center were incorporated. The sm IBDs were indicated in patients with common iliac artery aneurysms (CIAAs) and with a challenging anatomy and in those patients with or without abdominal aortic aneurysm (AAA). Fifteen patients (15 male, mean age 67.6±7.9years) were included. Fifteen sm IBDs were implanted in 1 procedure (100%). Fourteen (93.3%) patients had simultaneous endovascular aneurysm repair (EVAR) and 1 (6.7%) patient previously had a bilateral CIAAs repair by EVAR. The mean common iliac artery (CIA) diameter was 36.6±12.5mm. Technical success was obtained in all patients (100%). The median operation time was 189.7±78.6min, with a median fluoroscopy time of 45.3±15.9min. Axillary artery access was used in 11 (73.3%) procedures. The mean total hospital stay was 5.6±2.8days, and the postoperative follow-up was 35.4months (range 2-120). The estimated IIA bridge stent patency at 1year after operation was 100% and 85.7%±13.2% 5years postoperatively. One (6.7%) IIA branch was occluded, and this patient remained asymptomatic. One patient (6.7%) needed reintervention, and another (6.7%) patient had type II leakage, which is currently under close surveillance. Using an IBD to maintain the pelvic blood flow is an effective and feasible intravascular technique, especially for patients with an abnormal iliac artery anatomy. This novel technique has similar midterm procedural success rate compared to the use of commercial IBDs. Therefore, these devices are more suitable for patients with certain anatomic challenges and can be used as an alternative treatment.

Optimal bail-out and complication management strategies in protected high-risk percutaneous coronary intervention with the Impella.

Despite the routine use of percutaneous mechanical circulatory support (pMCS) with the Impella heart pump, vascular and bleeding complications may occur during removal with or without pre-closure. To safely close the large-bore access (LBA), post-hoc selection of the appropriate treatment of vascular complications is critical to patient recovery and survival. Femoral artery access is typically utilized for LBA, and percutaneous axillary artery access is a common alternative, especially in the instance of severe peripheral artery disease. Optimization of patient outcomes and efficiency of pMCS can be achieved with adequate arterial access using state-of-the-art techniques. Impella removal techniques with or without pre-closure will be addressed as well as the management of large-bore femoral access complications. In addition, treatment strategies to manage patient deterioration during a protected high-risk percutaneous coronary intervention will be provided.

Intra-aortic Balloon Pump Securement.

Intra-aortic Balloon Pump Securement.

Transaortic Placement of Percutaneous Mechanical Support Device via Partial Sternotomy: Feasible Option for Unsuitable Axillary Artery Access.

Acute decompensated refractory cardiogenic shock is an emergency in which the prompt instauration of mechanical circulatory support improves outcomes. The typical, initial approach for device delivery is via femoral vessels due to easy access and safety. If longer support is needed, the femoral access will severely impair the patient's mobility and can also limit the amount of support given as the new-generation devices are too large for direct arterial insertion. Upper-body arterial conduits (UBACs) are used for the delivery of larger, percutaneous ventricular assist devices (pVADs). The Impella 5.5 (Abiomed, Danvers, MA, USA) is a pVAD that can be deployed through a UBAC by either axillary/subclavian access or a transaortic approach. The latter approach is typically used in cases of postcardiotomy shock, in which the ascending aorta is already exposed through a full sternotomy. However, in some cases, the axillary artery is not suitable due to size (<6 mm in diameter), and a smaller pVAD is delivered into the heart. To avoid providing suboptimal support, we present an alternative, minimally invasive approach in which the larger device is delivered through the ascending aorta. This article summarizes the details of this approach through a mini upper partial sternotomy and reviews the relevant technical considerations.

Percutaneous proximal axillary artery versus femoral artery access for endovascular interventions: Presented at the Forty-third Annual Meeting of the Canadian Society for Vascular Surgery, Virtual Edition, September 24-25, 2021; and presented at the Thirty-sixth Annual Western Vascular Society Meeting for Vascular Surgery, Jackson Hole, Wyoming, October 16-19, 2021.

Objective: The primary objective of this study is to describe and illustrate the technique of ultrasound-guided percutaneous proximal axillary artery (PAA) access, and secondarily to evaluate the versatility and safety of this approach in peripheral, visceral, and aortic endovascular interventions.

Safety and Learning Curve of Percutaneous Axillary Artery Access for Complex Endovascular Aortic Procedures

Percutaneous axillary artery access is increasingly used for large-bore access during vascular and interventional cardiology procedures. The aim of this study is to evaluate the safety and learning curve of percutaneous axillary artery access in patients undergoing complex endovascular aortic repair (FBEVAR) requiring large-bore upper extremity access and to discuss best practices for technique and complication management.

Prognostic factors in real-world elective supported high risk percutaneous coronary intervention with pLVAD or ECMO

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): University Hospital of Salamanca - contract (CM19/00055) supported by the Instituto de Salud Carlos III in Spain (Co-funded by European Social Fund "Investing in your future"). Background/Introduction Percutaneous coronary intervention (PCI) is the last remaining revascularization option in high risk (HR) patients affected by complex coronary artery disease not suitable for surgery. Elective mechanical circulatory support (MCS) could be necessary to keep hemodynamics during these procedures. In this context, selection of the patients balancing the risk-benefit is a challenge. Purpose Analyse the factors related to mortality in patients who underwent elective HR-PCI with MCS: veno-arterial extracorporeal membrane oxygenation (VA-ECMO), Impella CP® or percutaneous heart pump (PHP). Methods The study is a retrospective single centre registry, including all elective MCS implants for HR-PCI in a referral hospital. All of them were previously discussed in clinical session, deciding this modality of intervention by the Heart Team. Univariate analysis of variables related to discharge survival was performed using SPSS Statistics. Results Twenty-seven patients underwent supported elective HR-PCI from 2013 to Sep-2021 (Figure 1). They were patients with low LVEF, high percentage of admission for ACS or HF, high coronary anatomy complexity (mean syntax score 31.4±9.5), and high surgical risk (mean STS morbidity-mortality score 24.17±16.0). In 88.9% of the patients, the circulatory support device was removed after completing the procedure, remaining in the rest due to persistent instability. The main access site was femoral, using axillary arterial access when the iliofemoral arteries were not suitable. Endotracheal intubation was needed in 29.6% of patients. Deaths during the admission (14.8%) were not directly related with the procedure but with posterior complications (alveolar haemorrhage, multiorgan failure, refractory heart failure and sepsis). Variables related to mortality were concomitant more than mild valvular heart disease; higher creatinine serum levels and lower pH before the procedure; axillary access and need for endotracheal intubation during or after the intervention; periprocedural mayor and minor bleeding and postprocedural critical care infections (Figure 1). We did not find other differences in terms of baseline characteristics, complexity of revascularization, type of support or development of complications. In the follow-up (median 4.8 [29.7] months) 70.4% of patients remain alive after the intervention (Figure 2). Conclusion Temporary MCS used prophylactically in elective high-risk PCI appeared feasible and safe in the real-world setting and could be an alternative for patients dismissed for surgery because of high-risk. Moreover, we found some prognostic variables related to discharge survival to help clinicians with the selection of the most appropriate patients. Randomized studies are required to determine a better selection of cases according to risk-benefit

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

Axillary artery access has become increasingly widespread as an alternative to the femoral route for large-bore transcatheter aortic valve replacement (TAVR), endovascular aortic repair (EVAR), and mechanical circulatory support (MCS) procedures. Advantages of percutaneous access include avoidance of a surgical incision, general anesthesia, and conduit graft infection. This statement aims to review the anatomic considerations and risks for percutaneous axillary artery access, suggest best practices for access techniques, hemostasis/closure strategies, and complication management, and recommend options for training and privileging.

B-40 | Percutaneous Axillary Artery Access in Children with Congenital Heart Disease

Percutaneous axillary artery access has been underutilized in children. In this study, we aimed to describe the efficacy and safety of percutaneous axillary access in complex pediatric transcatheter interventions.