Percutaneous Axillary Access in the Endovascular Era: A Viable Alternative

The common femoral artery is the most commonly used vascular access due to its low complication rate and high technical success rate. However, this approach may be less suitable in patients with certain factors such as obesity, the need to treat both lower limbs, and the inability to access the lesion via crossover. In this context, endovascular approaches using percutaneous puncture or upper arm access have emerged. Therefore, we evaluated the feasibility of percutaneous access to the axillary artery in routine endovascular procedures.

This single-center observational study included consecutive patients requiring percutaneous access to the axillary artery for endovascular procedures from January 2020 to December 2023. Demographic and procedural characteristics were collected. The primary end point was efficacy (technical success rate) and safety (complications rate) at 30 days. Secondary end points were minor complications and risk factors of complications.

Eight-five patients were included. Axillary approach was used to treat peripheral artery disease (PAD) in 77.6% (n = 66), complex aortic aneurysm in 17.7% (n = 15), and acute type B aortic dissection in 4.7% (n = 4) of patients. This approach was used due to bilateral PAD treatment (n = 20), obesity (n = 18), prior endovascular aortic repair (n = 12), prior common femoral artery stenting (n = 9), major iliac tortuosity (n = 9), prior kissing stent (n = 8), favorable angulation (n = 5), and true lumen positioning in type B aortic dissection (n = 4). The left axillary approach was used in 97.6% (n = 83) of cases. The efficacy was 100%. At 30 days, safety was 85.6% with a major complication rate of 14.2% (n = 12), including 10.6% (n = 9) surgical conversion for hemostasis, 2.4% (n = 2) covered stenting, and 1.2% (n = 1) stroke. Body mass index was associated with a higher rate of complications (25.2 ± 6.17 vs. 29.0 ± 6.04, odds ratio: 1.2 [1.05; 1.37], P = 0.006).

Axillary arteries are an effective alternative access route for patients with unsuitable iliofemoral arteries. Randomized clinical trials are needed to confirm our findings and to assess the best approach for the upper arm.