Axillary Artery Approach for Ductal Stenting in Neonates and Infants

Ductal stenting in patients with unusual arterial duct anatomy presents a challenge. The axillary artery (AA) approach provides a safe and effective alternative for access, particularly when conventional femoral routes fail. A retrospective analysis was conducted on patients with ductal-dependent pulmonary blood flow who underwent ductus arteriosus (DA) stenting via the AA route between November 2018 and December 2022 at two tertiary cardiac centers. Demographic and procedural data were reviewed. The study included 39 patients, mostly neonates and infants with complex DA anatomy. The median age was 11 days (IQR7-15 days), and the median weight was 3000 g (IQR 2700-3400 g). Pulmonary atresia was diagnosed in 30 patients, and 9 had antegrade flow. The AA approach was the primary choice in 15 patients (38%) and used as a secondary option after femoral failure in others. Ultrasound-guided puncture was performed in 15 cases. Thirty-five out of 39 patients (89%) had procedural success, which is defined as stent insertion without the requirement for prostaglandin infusion. The median fluoroscopy and procedure times were 17.1 and 68 min, respectively. Including one temporary brachial plexus injury and access-related events, the overall complication rate was 22% (8/35). Most complications occurred early in the learning curve and were managed without long-term sequelae. The AA is a safe and effective alternative for stenting complex or tortuous ductus arteriosus, especially when femoral access is unsuccessful. It provides favorable alignment and procedural control without significantly increasing procedure or fluoroscopy times.