Percutaneous large-bore axillary access is a safe alternative to surgical approach: A systematic review

Area of Science:

• Cardiovascular Interventions
• Vascular Access Techniques
• Interventional Cardiology

Background:

• Severe peripheral arterial disease (PAD) can preclude traditional femoral artery access for cardiac interventions.
• The axillary artery serves as an alternative access route for procedures like transcatheter aortic valve replacement (TAVR) and mechanical circulatory support.
• Limited comparative data exists between percutaneous transaxillary (pTAX) and surgical transaxillary (sTAX) approaches.

Purpose of the Study:

• To systematically review and compare cardiovascular outcomes of large-bore axillary arterial access using percutaneous and surgical methods.
• To evaluate the safety and efficacy of pTAX versus sTAX approaches in patients undergoing cardiac interventions.

Main Methods:

• A systematic literature search of Pubmed and Medline databases was conducted up to January 2019.
• Studies involving pTAX or sTAX approaches for TAVR or Impella insertion were included.
• Primary outcomes assessed included access-related mortality, 30-day mortality, stroke, major vascular complications, and major bleeding.

Main Results:

• Twenty-two studies met inclusion criteria, with heterogeneous patient data (69% TAVR/31% Impella for pTAX; 96% TAVR/4% Impella for sTAX).
• The pTAX group experienced more cardiogenic shock.
• Compared to sTAX, pTAX showed similar 30-day mortality, stroke rates, and major vascular complications, but significantly less major bleeding (2.7% vs. 17.9%).

Conclusions:

• Large-bore percutaneous transaxillary access demonstrates comparable 30-day mortality, stroke rates, and major vascular complications to the surgical transaxillary approach.
• The percutaneous approach offers a significant advantage by reducing major bleeding events.
• Further studies are warranted to validate these findings.