The IABP is frequently used device to support patients with heart failure. An alternative approach to the transfemoral technique is attractive especially with an anticipated long length of support where ambulation is desired. Accordingly, we developed a technique to percutaneously place IABPs in the axillary-subclavian artery position in a select group of patients. Methods: Retrospective review to highlight the clinical experience of 19 patients referred to our HF service that were supported by a axillary-subclavian IABPs. A 4F sheath is placed in either the femoral or left brachial artery and a J-guide wire is then inserted using fluoroscopy and placed in the subclavian artery to guide direct puncture. Left axillary-subclavian arterial access is obtained using a lateral approach, 3 to 4 cm lateral to the midpoint of the clavicle and direct punture aimed to the guide wire. The IABP is placed by fluoroscopic guidance into the descending thoracic aorta. The IABP was removed by either manual pressure or with the use of a percutaneous closure device. Baseline demographics, total duration of support and adverse events are reported. Results: Mean age 57 ± 9 years, 79% male, 74% with underlying ICM, LVEF 21 ± 7%, LVEDd 6.3 ± 1.2 cm; mean PCWP 21 ± 9 mmHg, mean PAP 35 ± 10 mmHg, mean RAP 12 ± 7 mmHg, and CI 2.1 ± 0.4 l/min/m2. Nine patients were successfully bridged to heart transplantation after 23 ± 12 days of support plus 1 patient with ongoing support for a total of 19 days to date. Three patients with cardiogenic shock improved clinically after 20 ± 9 days of support. One patient was bridged to permanent LVAD after 16 days. One patient was supported during a high risk PCI. Four patients deemed high risk for urgent transplantation were supported for 14 ± 4 days prior to dying. Sixteen of the 19 patients ambulated daily without complications. No significant bleeding or neurologic events were noted after the procedure, during support, or after removal of the device. Two patients required left brachial artery embolectomy without long-term consequence. Conclusion: Percutaneous insertion of an IABP through the left axillary-subclavian artery is feasible, allows for ambulation and is associated with a relatively low risk profile. Larger, prospective studies are warranted. The IABP is frequently used device to support patients with heart failure. An alternative approach to the transfemoral technique is attractive especially with an anticipated long length of support where ambulation is desired. Accordingly, we developed a technique to percutaneously place IABPs in the axillary-subclavian artery position in a select group of patients. Methods: Retrospective review to highlight the clinical experience of 19 patients referred to our HF service that were supported by a axillary-subclavian IABPs. A 4F sheath is placed in either the femoral or left brachial artery and a J-guide wire is then inserted using fluoroscopy and placed in the subclavian artery to guide direct puncture. Left axillary-subclavian arterial access is obtained using a lateral approach, 3 to 4 cm lateral to the midpoint of the clavicle and direct punture aimed to the guide wire. The IABP is placed by fluoroscopic guidance into the descending thoracic aorta. The IABP was removed by either manual pressure or with the use of a percutaneous closure device. Baseline demographics, total duration of support and adverse events are reported. Results: Mean age 57 ± 9 years, 79% male, 74% with underlying ICM, LVEF 21 ± 7%, LVEDd 6.3 ± 1.2 cm; mean PCWP 21 ± 9 mmHg, mean PAP 35 ± 10 mmHg, mean RAP 12 ± 7 mmHg, and CI 2.1 ± 0.4 l/min/m2. Nine patients were successfully bridged to heart transplantation after 23 ± 12 days of support plus 1 patient with ongoing support for a total of 19 days to date. Three patients with cardiogenic shock improved clinically after 20 ± 9 days of support. One patient was bridged to permanent LVAD after 16 days. One patient was supported during a high risk PCI. Four patients deemed high risk for urgent transplantation were supported for 14 ± 4 days prior to dying. Sixteen of the 19 patients ambulated daily without complications. No significant bleeding or neurologic events were noted after the procedure, during support, or after removal of the device. Two patients required left brachial artery embolectomy without long-term consequence. Conclusion: Percutaneous insertion of an IABP through the left axillary-subclavian artery is feasible, allows for ambulation and is associated with a relatively low risk profile. Larger, prospective studies are warranted.