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Suggested Bony Landmarks for Safe Axillary Artery Access
Mohammad Thawabi, Rajiv Tayal, Zain Khakwani
1Newark Beth Israel Medical Center, 201 Lyons Avenue at Osborne Terrace, Newark, NJ 07112 USA. najam.wasty@rwjbh.org.
The Journal of Invasive Cardiology
|March 2, 2018
Summary
A fluoroscopic bony landmark, the inferior glenoid cavity, aids safe percutaneous axillary artery cannulation. This landmark helps avoid injury to the brachial plexus and subscapular artery during catheter-based procedures.
Area of Science:
- Vascular anatomy
- Interventional radiology
- Surgical landmarks
Background:
- Percutaneous axillary artery cannulation is a crucial alternative access site for catheter-based procedures.
- Currently, no defined bony landmarks exist to guide this procedure safely.
- Identifying such a landmark is vital for minimizing procedural risks.
Purpose of the Study:
- To identify a reliable fluoroscopic bony landmark for safe percutaneous axillary artery cannulation.
- To establish a correlation between a bony landmark and the axillary artery's anatomy.
- To provide guidance for avoiding critical structures during axillary artery access.
Main Methods:
- Retrospective analysis of 51 percutaneous axillary artery sheath angiograms.
- Correlation of a fixed bony landmark with the proximal end of the third part of the axillary artery.
- Assessment of the relationship between the landmark and the origin of the subscapular artery.
Main Results:
- The inferior border of the glenoid cavity was identified as a consistent fluoroscopic landmark.
- The subscapular artery originated at or distal to the inferior glenoid border in all patients (arm abducted at 135°).
- The origin was within 20 mm distal to the glenoid border in all cases.
Conclusions:
- The inferior glenoid cavity serves as a reliable fluoroscopic landmark for axillary artery cannulation.
- Cannulation medial to this landmark theoretically spares the brachial plexus and subscapular artery.
- This finding enhances the safety of percutaneous axillary artery access.
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