Percutaneous Transaxillary Access for Large-Bore Cardiovascular Interventions: Evidence, Technique, and Complication...

Area of Science:

• Cardiovascular Interventions
• Vascular Access Techniques
• Interventional Cardiology

Background:

• Percutaneous transaxillary access is an alternative to transfemoral access for large-bore arterial procedures.
• It is particularly useful for patients with challenging iliofemoral anatomy.
• The axillary/subclavian approach presents unique technical and anatomical considerations.

Purpose of the Study:

• To provide a practical framework for percutaneous transaxillary access.
• To summarize clinical evidence, technical aspects, and complication management.
• To offer procedural tips for enhancing safety and reproducibility.

Main Methods:

• Review of contemporary clinical evidence and procedural techniques.
• Emphasis on pre-procedural imaging and patient selection.
• Guidance on ultrasound/angiographic puncture and closure strategies.

Main Results:

• Transaxillary access overcomes iliofemoral limitations and allows patient mobilization during mechanical circulatory support (MCS).
• Meticulous planning, precise guidance, and appropriate closure are crucial.
• Familiarity with suture-based and balloon-assisted closure is important.

Conclusions:

• Percutaneous transaxillary access is a viable option when transfemoral access is difficult.
• Careful technique and closure management are key to success.
• This review aims to standardize and improve the safety of the procedure.