Single-access during Impella hemodynamic support utilizing the Railway system

A single-access technique during mechanical circulatory support (MCS) and percutaneous coronary intervention (PCI) has been described for those patients where an additional arterial access site is not available or desired. This technique utilizes the Impella (Abiomed, Danvers, MA) 14 French (F) sheath as a single-access point, with a 7 F sheath through the 14 F sheath hemostatic valve next to the Impella catheter (Abiomed). However, this technique is limited to a 7 F sheath or smaller and can be difficult requiring multiple attempts and limit guide catheter manipulation. We describe a single-access technique utilizing the Impella (Abiomed) 14 F sheath and a standard 7 F guide catheter placed sheathless through the 14 F sheath hemostatic valve utilizing the Railway Sheathless Access System (Cortis, Santa Clara, CA).