Transfemoral Arterial Approach Research Articles

Transradial versus transfemoral access for diagnostic cerebral angiography: frequency of acute MRI findings in 500 consecutive patients at a single center

BackgroundThe frequency of clinically symptomatic and asymptomatic diffusion-weighted imaging (DWI) hyperintense lesions and their correlation with the transradial artery (TRA) approach is unclear.ObjectiveTo assess the frequency of abnormal diffusion restriction...

Abstract 220: Transradial Access Versus Transfemoral Approach for Carotid Artery Stenting: A Systematic Review and Meta‐analysis

Introduction Carotid artery stenting (CAS) has emerged as a viable alternative to carotid endarterectomy for managing carotid artery stenosis in high‐risk patients (1). While the transfemoral arterial approach (TF) remains the preferred method, it is associated with inherent limitations and potential complications (2‐4). Consequently, exploring the transradial artery access (TR) as a potential option becomes crucial in optimizing patient outcomes and procedural success rates. Limited data exists comparing the outcomes of TR approach in CAS to TF approach. This study aims to systematically review and meta‐analyze the outcomes and complication rates between TR and TF access for CAS. Methods A systematic electronic search was conducted in four databases up to May 10th, 2023. Studies with randomized or non‐randomized designs, involving CAS through TR or TF approach, were included. Outcomes of interest were stroke, transient ischemic attack (TIA), death, myocardial infarction (MI), and access site complications. A meta‐analysis was performed, analyzing pooled odds ratios (ORs) and 95% confidence intervals (CI) to assess the effect size of the vascular access approaches. Results Six studies with a total of 6,917 patients were included, out of which 602 (8.7%) underwent the TR approach, and 6,315 (91.3%) underwent the TF approach. Meta‐analysis results showed no significant difference in stroke occurrence between TR and TF groups (TR: 1.7% vs. TF: 1.9%; OR = 0.98; 95% CI 0.49 – 1.96; I2 = 0%). Similarly, no significant difference was found in death (TR: 1% vs. TF: 0.9%; OR = 0.95; 95% CI 0.38 – 2.37; I2 = 0%), MI (TR: 0.2% vs. TF: 0.3%; OR = 1.53; 95% CI 0.20 – 11.61; I2 = 0%), TIA (TR: 0.4% vs. TF: 1%; OR = 0.46; 95% CI 0.11 – 1.95; I2 = 0%), and access site complications (TR: 2.2% vs. TF: 1%; OR = 0.97; 95% CI 0.48 – 1.98; I2 = 0%). Conclusion In the comparison of TR and TF approaches for CAS, no significant differences were observed in stroke, death, MI, TIA, or access site complications. TR approach shows promise as an alternative method for CAS, offering potential benefits without increased risk of complications. However, further studies are needed to confirm these findings and establish guidelines for optimal access site selection.

Transradial intra-aortic catheter looping in the angioplasty of severe intracranial symptomatic arteriosclerotic diseases.

This study aims to investigate the effect and feasibility of intra-aortic catheter looping via transradial access in angioplasty for symptomatic intracranial severe (>70%) atherosclerotic stenosis or occlusion of large arteries (SISOLAs). Patients with SISOLAs who underwent transradial endovascular angioplasty using the catheter looping technique in the ascending aorta were retrospectively enrolled. The clinical data and treatment outcomes were analyzed. Fifteen patients aged 48-71 years were enrolled in this study. Left vertebrobasilar artery occlusion was present in 1 (6.7%) patient, severe left middle cerebral artery stenosis in 7 (46.7%) patients, severe left internal carotid artery (ICA) stenosis of the ophthalmic segment in 4 (26.7%) patients, severe left ICA stenosis of the cavernous segment in 2 (13.3%) patients, and severe right middle cerebral artery stenosis in 2 (13.3%) patients. The arterial stenosis ranged from 70 to 92% (mean 86%) before stenting. The looping of a guiding catheter in the ascending aorta via transradial access for angioplasty was successful in all patients (100%). The vertebral artery intracranial segment occlusion was successfully recanalized, while severe stenosis in the remaining 14 patients was successfully eliminated. After endovascular recanalization, the residual stenosis was reduced by 12-26% (median 18%). No puncture-related complications or surgical-related neurological complications occurred in these patients. In the follow-up angiography conducted on 10 (66.7%) patients after 6-25 months, no in-stent restenosis was detected. Intra-aortic guiding catheter looping via transradial access for endovascular angioplasty of SISOLAs is technically safe, feasible, and effective, especially when the transfemoral artery approach is difficult or impossible to undertake.

Comparative Analysis of Transradial and Transfemoral Arterial Approach When Performing Diagnostic Coronary Angiography.

The transfemoral (TF) arterial approach is still the most commonly used approach for performing diagnostic coronary angiography in most centers in the world as well as in Bosnia and Herzegovina. Recently, the transradial (TR) arterial approach has gained more and more supporters among interventional cardiologists. The aim of the study was to compare the duration of the procedure, the amount of delivered ionizing radiation, the amount of applied contrast agent, the frequency of procedural complications and patient comfort during coronary angiography performed via TR and TF arterial approach. The total sample of 240 respondents was divided into two groups in such a way that the first group consisted of 121 respondents who underwent coronary angiography using TR arterial approach, and the second group consisted of 119 respondents who underwent coronary angiography using TF arterial approach. The Mann-Whitney U test was used to verify the research objective. The obtained research results showed that the duration of coronary angiography and the amount of radiation was greater when using TR arterial approach compared to TF approach. There is no statistically significant difference in relation to the amount of applied contrast medium and the frequency of complications between the two approaches. Periprocedural and postprocedural comfort was better in patents who underwent TR approach. The findings of this study show that diagnostic coronary angiography performed via the TR arterial approach is as safe for the patient as diagnostic coronary angiography performed via the TF arterial approach. With both approaches, there is no significant difference in the amount of contrast agent used nor in the frequency of complications. Procedure duration and radiation exposure are shorter when TF arterial approach i used, while patient comfort is better when the TR arterial approach is used.

Endovascular Management of Ruptured Renal Angiomyolipoma: A Case Report

Renal angiomyolipoma is classified as a benign tumour comprising fat, smooth muscle cells, and vascular tissue. Renal giant angiomyolipoma with rupture is a relatively rare clinical emergency condition. Here, the authors present a case of a 37-year-old female patient who presented with complaints of right flank pain for six hours. The patient was anaemic and did not have haematuria. On non contrast Computed Tomography (CT) imaging, there was a right perirenal haematoma with a mixed-density, fat-containing tumour in the upper interpolar region of the right kidney. On Contrast-Enhanced Computed Tomography (CECT) imaging, the right renal tumour showed multiple abnormal tortuous vessels with moderate to intense enhancement, consistent with a large angiomyolipoma. She was managed with primary therapeutic endovascular embolisation for a ruptured right renal angiomyolipoma under local anaesthesia via a right transfemoral artery approach. The procedure was uneventful, and postembolisation syndrome was managed with medications. The patient was discharged in a stable condition. During the one-month follow-up, the patient’s symptoms improved, and the need for major surgery like nephrectomy was avoided. Super selective embolisation to devascularise the tumour and preserve renal parenchyma was done under local anaesthesia via a right transfemoral approach without any complications. Postembolisation syndrome was managed medically

Remimazolam Requires Less Vasopressor Support during Induction and Maintenance of General Anesthesia in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement: A Retrospective Analysis from a Single Center.

Introduction We compared the hemodynamics during general anesthesia with remimazolam and conventional anesthetics in patients with severe aortic stenosis (AS). Methods This was a retrospective single-center analysis. We reviewed the records of 42 patients who underwent transcatheter aortic valve implantation with a transfemoral artery approach under general anesthesia from January to December 2020. Patients were divided into three groups based on the general anesthetic used for (induction/maintenance) remimazolam/remimazolam (Group R/R), propofol/sevoflurane (Group P/S), and midazolam/propofol (Group M/P). Vasopressor use (ephedrine, phenylephrine, and noradrenaline) was compared among the groups. Results The number of patients in each group was 15 (Group R/R), 13 (Group P/S), and 14 (Group M/P), with no significant difference in background characteristics and intraoperative vital signs. For anesthesia induction, doses of ephedrine and phenylephrine used were significantly lower in Group R/R (ephedrine [mg]: Group R/R 2 [0–4] vs. Group P/S 8 [8–12], P < 0.001, Group R/R vs. Group M/P 5 [0–15], P = 0.39; phenylephrine (mg): Group R/R 0 [0–0.08] vs. Group P/S 0.15 [0.10–0.20], P = 0.03, Group M/P 0.21 [0.04–0.40], P = 0.08). For anesthesia maintenance, the noradrenaline dose used was low in the Group R/R (noradrenaline [μg/kg/min]: Group R/R 0.019 [0.015–0.039], Group P/S 0.042 [0.035–0.045], P = 0.02, Group M/P 0.048 [0.040–0.059], P < 0.01). Conclusion In patients with severe AS, induction and maintenance of anesthesia with remimazolam resulted in less overall vasopressor use than conventional general anesthetics.

Stenting of critical aortic coarctation in neonates between 600 and 1,350 g. Using a transfemoral artery approach. A single center experience.

BackgroundStenting of aortic coarctation (CoA) in newborns with a very low bodyweight remains rare and challenging. In this study we aim to highlight on two points: first the feasibility of CoA stenting in such babies and second the importance of using echocardiogram for guiding the intervention without the need for contrast agent.MethodsBetween 2020 and 2022 three preterm babies with very low (VLWB) and extremely low weight (ELWB) underwent CoA-stenting in our center. The weight of the patients at time of intervention was 1,350, 1,200, and 600 g, respectively. The femoral artery was chosen in all patients as vascular access. Transthoracic echocardiography, sonography of the femoral arteries and head ultrasound were applied for follow up.ResultsAll three interventions were successfully done, with no complications. Coronary stents were implanted. In one Patient (1,350 g) the stent was inserted without sheath. In two patients with renal failure, the stenting was performed under echocardiography-guidance without contrast agent. The follow up showed a preserved function of the left ventricle in all patients. No relevant gradient was reported and no stent re-intervention was required. Sonographic follow up showed a patent femoral artery in all patients. Two patients were operated 73 and 110 days after stenting, and the stents were successfully removed. In the third patient the intervention was performed 130 days ago and he is waiting for the operation.ConclusionCoA-stenting in VLWB and ELWB is feasible and can bridge them to the next surgery without complications. Echocardiography-guided CoA-stenting in VLWB is a considerate option especially in patients with renal failure. Accessing the femoral artery by experienced doctors, using local anesthesia before the puncture and before removing the sheath might help to protect the vessel from stenosis or occlusion.

Safety and Efficacy of Radial Versus Femoral Artery Access for Mechanical Thrombectomy Procedures Following Intravenous Administration of Tissue Plasminogen Activator

Background The transradial artery (TRA) approach for neuroendovascular procedures is a safe and effective alternative to the transfemoral artery (TFA) approach. We compared the efficiency and periprocedural outcomes of TRA and TFA approaches for acute stroke interventions in patients receiving intravenous tissue plasminogen activator. Methods A retrospective cohort study analyzed data from patients at a large cerebrovascular center from January 1, 2014, to March 31, 2021. Baseline characteristics, periprocedural efficiency and efficacy, and in‐hospital outcomes were compared between intervention cohorts (TRA and TFA). Results Of 314 patients analyzed, 21 (7%) underwent a TRA approach and 293 (93%) underwent a TFA approach. Complications occurred in one (5%) of 21 patients in the TRA cohort and 20 (7%) of 293 patients in the TFA cohort. Access site complications were present in 12 (4%) patients with TFA, and no patients with TRA experienced access site complications. The mean length of stay was significantly longer for the TFA cohort (8.8 days [standard deviation, 8.5 days]) versus the TRA cohort (4.8 days [standard deviation, 2.9 days]) ( P =0.02). Linear regression analysis showed that femoral access, Medicaid insurance, and discharge National Institutes of Health Stroke Scale score &gt;10 predicted longer length of stay ( P ≤0.046). However, when the time to initial physical or occupational therapy session was added to the model, access site was no longer significant ( P =0.42). Conclusion The TRA approach may reduce periprocedural complications and hospital length of stay compared with the TFA approach. The shorter length of stay associated with TRA access appeared to be associated with earlier initiation of physical or occupational therapies.

Transradial versus transfemoral arterial approach for cerebral angiography and the frequency of embolic events on diffusion weighted MRI

BackgroundThe radial artery approach has become popular as a ‘radial first’ strategy for arterial access in neuroangiography and neurointerventions. Recent studies have shown that transradial arterial access (TRA) for cerebral...

Impact of Transradial Versus Transfemoral Artery Approach for Pre-Procedural Coronary Angiography on Outcomes in Patients Undergoing Subsequent TAVR

Impact of Transradial Versus Transfemoral Artery Approach for Pre-Procedural Coronary Angiography on Outcomes in Patients Undergoing Subsequent TAVR

THE INFLUENCE OF THE PATIENT'S AGE ON THE DURATION OF THE PROCEDURE AND THE AMOUNT OF RADIATION DELIVERED WHEN PERFORMING DIAGNOSTIC CORONARY ANGIOGRAPHY

The aim of the research was to determine whether the age of the patient affects the duration of the procedure and the amount of ionizied radiation delivered when performing diagnostic coronary angiography. The research was conducted at the Clinic for Invasive Cardiology of the Public Health Institution "University Clinical Center" Tuzla in the period from December 2018. to January 2020. The research included a total sample of 240 respondents, average chronological age of 62.60 ± 9.22 years, ranging from 24 to 85 years. Out of a total of 240 respondents, in 121 respondents coronarny angiography was performed using transradial arterial approach and 119 by performing a transfemoral arterial approach. The total sample was divided into two subsamples of respondents. The first sub-sample consists of respondents up to 65 years of age, and the second sub-sample consists of respondents over 65 years of age. During each performance of coronary angiography, the duration of the procedure (in minutes and seconds) and the amount of radiation delivered during the procedure (in mGy) were measured. The research data were processed using the method of parametric and non- parametric statistics. The Mann-Whitney U test was used to verify the research objective. Based on the obtained research results, it can be concluded that in patients over 65 years of age, the duration of the coronary angiography procedure is longer, and is at the limit of statistical significance (p= 0.057). The amount of delivered radiation is higher in respondents over 65 years of age, but it is not statistically significant (p= 0.396). Keywords: Coronary angiography, coronary disease, procedure duration, age, amount of delivered radiation.

Treatment of Coral Reef Aorta by Endovascular VIABAHN VBX Balloon-Expandable Stent-Graft Placement.

Coral reef aorta (CRA) has been described as a rare disease characterized by the presence of dense calcifications of the aorta. In this study, we report on two patients with CRA caused by intermittent claudication (IC) who underwent endovascular VIABAHN VBX balloon-expandable stent-graft (VVBX) placement. Both patients underwent successful endovascular VVBX placement via transfemoral artery approach, and hemostasis was achieved via vascular closure device. Their symptoms were observed to disappear completely after treatment, and they were discharged without serious adverse events. No symptoms were noted at 1.5-year and 1-year follow-up.

Abstract P539: Comparison of Transradial Artery versus Transfemoral Artery Access for Solumbra Technique in Mechanical Thrombectomy

Introduction: Solumbra technique involves the simultaneous use of stent-retriever and large-bore aspiration for clot retrieval in mechanical thrombectomy (MT). We aim to compare various time parameters in patients who undergo MT via solumbra technique via transradial artery (TRA) approach vs. transfemoral artery (TRF) approach. Methods: We performed a retrospective chart review of patients who underwent MT via solumbra technique for anterior circulation large vessel occlusion at a comprehensive stroke center from 7/2014 to 5/2020. We compared time to recanalization parameters, score of TICI≥2b, and functional independence (3-month mRS≤2) in patients who underwent MT via TRA vs.TRF approach via the solumbra technique. A binary logistic regression analysis was performed, controlling for age, sex, pre-treatment-NIHSS, type of anesthesia (general vs.moderate), laterality, and clot location [proximal (internal carotid or M1 segment of the middle cerebral artery) vs.distal (M2 or M3 segment of the middle cerebral artery)]. Results: A total of 98 patients met our inclusion criteria. The mean age was 63.59±14.40 years. 18 (18.37%) patients underwent MT through transradial approach. In our cohort, there was a significant association of TRA with shorter angio suite arrival-time to puncture-time (22.12±9.92mins vs.28.83±12.26mins; OR, 0.94; 95% CI, 0.88-1; P 0.026), but not with puncture-time to recanalization-time (84.34±61.34mins vs.63.73±35.29mins; OR, 1.01; 95% CI, 1-1.03; P 0.085), angio suite arrival-time to recanalization-time (103.12±51.29mins vs.93.42±39.08mins; OR, 1.01; 95% CI, 1-1.02; P 0.524), number of passes to recanalization (1.78±1.36 vs.1.68±1.05; OR, 1.03; 95% CI, 0.66-1.63 ; P 0.899), number of patients with TICI≥2b (83.34% vs.91.25%; OR, 0.68; 95% CI, 0.14-3.4; P 0.633), and functional independence (66.67% vs.78.75%; OR, 0.49; 95% CI, 0.13-1.86; P 0.292), when compared to TRF approach for MT using solumbra technique. Conclusion: Our study demonstrates a significant association between TRA approach with shorter angio suite arrival-time to puncture-time but not with overall time to recanalization, number of patients with TICI≥2b, and functional independence, when compared to TRF approach for MT using solumbra technique.

Intra-Arterial Tissue Plasminogen Activator for Central Retinal Artery Occlusion

PurposeTo investigate the benefit of early intra-arterial tissue plasminogen activator (IAT) for treatment of central retinal artery occlusion (CRAO).Patients and MethodsFifteen eyes of 15 patients presenting with acute CRAO were included in this retrospective consecutive interventional case series. Patients were excluded if treatment with IAT was not initiated within 12 hours. The diagnosis was confirmed by an ophthalmologist. IAT was performed via a transfemoral arterial approach. Tissue plasminogen activator (tPA) was infused into the ophthalmic artery in aliquots up to 3mg to a maximum of 22mg. Paracentesis was done at the ophthalmologist’s discretion. The primary outcome measure was visual acuity after three weeks. Adverse events were recorded during treatment and follow-up visits.ResultsAfter treatment with IAT, there was a statistically significant improvement in visual acuity, with a mean change of −0.76 (SD 0.91; range −2.4 to 0.85) logMAR (p=0.006). Vision improved by 3 or more lines in 53%, and of these, the mean Snellen visual acuity improvement was >6 lines. Notably, 4 patients (27%) improved from CF or worse to 20/80 or better. The mean dose of tPA used was 17mg and the mean time to treatment was 8.83 hours (range: 5.5 to 12 hours). There were no statistically significant differences based on time to treatment, dose of tPA, or use of a paracentesis. No major adverse events were recorded.ConclusionIAT was safe and showed significant visual improvement in this small uncontrolled study. Larger studies and efforts to decrease time to treatment should be initiated to optimize outcomes.

Intraoperative Nursing Care of Patients Undergoing Transcatheter Aortic Valve Replacement via Femoral Artery Approach

<i>Objective:</i> Intend to explore the main points of intraoperative nursing care of patients with aortic valve stenosis undergoing transcatheter aortic valve replacement through femoral artery approach, summarize the scientific and effective nursing methods in operation. <i>Methods:</i> The intraoperative nursing methods of 9 patients undergoing transcatheter aortic valve replacement through femoral artery approach in our hospital from November 2019 to January 2021 were analyzed retrospectively. These methods include preoperative preparation, transmission of operative consumables, invasive blood pressure monitoring, use of high pressure syringe and temporary pacemaker, nursing of balloon dilatation and valve release, observation and nursing of intraoperative complications, postoperative nursing and so on. <i>Results:</i> The success rate of transcatheter aortic valve replacement was 100% in 9 patients who underwent transcatheter aortic valve replacement through femoral artery approach. In addition, the average operation time was 194.1 minutes. Besides, 1 case was implanted with middle valve, 1 case was protected by coronary artery, and 1 case was rescued during postoperative transportation. Moreover, no serious operative complications such as valve stent shedding, perivalvular leakage, coronary artery occlusion, stroke and malignant arrhythmia occurred in 9 patients. <i>Conclusion:</i> Full preoperative preparation, familiarity with the whole operation process and key steps, proficiency in the use of high pressure syringe and temporary pacemaker and nursing cooperation during balloon dilatation and valve release are the key to the successful completion of the operation in transfemoral approach transcatheter aortic valve replacement. Through active and effective intraoperative nursing, the operative quality of transfemoral artery approach transcatheter aortic valve replacement can be improved effectively, the operative time can be shortened, and the occurrence of intraoperative complications can be reduced, and the life safety of patients can be guaranteed.

High-intensity transient signals during transcatheter aortic valve implantation assessed by ultrasonic carotid artery blood-flow monitoring: A single center prospective observational study

BackgroundNo reports to date have assessed the procedural patterns of high-intensity transient signals (HITS) by monitoring blood flow in cervical arteries. The aim of this study was to examine the sequential distribution of HITS in each procedural phase and predictive factors for HITS during transcatheter aortic valve implantation (TAVI) by monitoring blood flow in the common carotid artery. MethodsThis prospective observational study included 73 patients who underwent TAVI via the transfemoral artery approach. We continuously evaluated and analyzed HITS from administration of heparin to valve implantation. ResultsHITS peaked during balloon valvuloplasty (BAV), amounting to almost 30% of the total HITS count, followed by valve implantation [BAV 141 (73–186) and valve implantation 86 (64–126), respectively]. In univariate and multivariate analysis, the Agatston score of the aortic valve and low-density lipoprotein were confirmed as independent predictors of HITS frequency with logarithmically converted coefficients of 0.00015 (p < 0.001) and 0.0032 (p = 0.027), respectively. ConclusionsThese results provide the first evidence that micro-emboli deriving from calcified burden were scattered primally during BAV, followed by valve implantation. The Agatston score may be a predictor for the amount of HITS.

Transcarotid repair of carotid artery pseudoaneurysm after carotid artery endarterectomy with tandem distal internal carotid artery stenosis.

Pseudoaneurysm development after carotid endarterectomy is a rare occurrence. Even rarer is pseudoaneurysm formation associated with a distal carotid artery stenosis. We report the case of stent grafting of a carotid artery pseudoaneurysm and tandem high-grade distal stenosis through a transcarotid approach with active flow reversal. No reported cases of a transcarotid artery approach to address a carotid artery aneurysm with tandem stenosis were found in the literature. We show that it may be a safe alternative to a transfemoral artery approach or open surgery.

Complications of femoral versus radial access in neuroendovascular procedures with propensity adjustment

BackgroundThe transradial artery (TRA) approach for neuroendovascular procedures continues to gain popularity, but neurointerventionalists still lag behind interventional cardiologists in the adoption of a TRA-first approach. This study compares the...

A Review of Alternative Access for Transcatheter Aortic Valve Replacement.

With the advent of transcatheter aortic valve replacement (TAVR), appropriately selected intermediate-, high-, and extreme-risk patients with severe aortic stenosis (AS) are now offered a less invasive option compared to conventional surgery. In contemporary practice, TAVR is performed predominantly via a transfemoral arterial approach, whereby a transcatheter heart valve (THV) is delivered in a retrograde fashion through the iliofemoral arterial system and thoraco-abdominal aorta, into the native aortic valve annulus. While the majority of patients possess suitable anatomy for transfemoral arterial access, there is a subset of patients with extensive peripheral vascular disease that precludes this traditional approach to TAVR. Fortunately, innovation in the field of structural heart disease has led to the refinement of alternative access options for THV delivery. Selection of the most appropriate route of therapy mandates a careful consideration of multiple factors, including patient anatomy, technical feasibility, and equipment specifications. Furthermore, understanding the risks conferred by each access site for valve delivery-notably stroke, vascular injury, and major bleeding-is of paramount importance when selecting the approach that will best optimize the outcome for an individual. In this review, we provide a comprehensive summary of alternative approaches to transfemoral arterial TAVR as well as the available outcome data supporting each of these various techniques.

Ambulatory Intra Aortic Balloon Pump in Advanced Heart Failure.

Cardiac transplantation is the gold standard treatment for patients with advanced congestive heart failure that is refractory to maximal medical therapy. However, donor heart availability remains the major limiting factor, resulting in a large number of patients waiting long periods of time before transplantation. As a result, mechanical circulatory support devices have been increasingly used as a 'bridge' in order to sustain organ function and stabilise haemodynamics while patients remain on the transplant waiting list or undergo left ventricular assist device surgery. Intra aortic balloon pumps (IABP) are commonly used for temporary circulatory support in patients with advanced heart failure. IABP is traditionally placed percutaneously through the transfemoral artery approach. The major limitation with this approach is ambulatory restriction that can promote deconditioning, particularly in situations of prolonged circulatory support. A subclavian/axillary artery approach IABP insertion allows patients to be ambulatory during the pre-transplant period. In this review, we aim to summarise the physiology of IABP, the evidence for its use in advanced CHF and the efficacy and safety of subclavian artery IABP insertion.