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Selective coronary arteriography by percutaneous transaxillary approach
Insights
Percutaneous axillary artery cannulation offers a safe and effective alternative for coronary angiography, especially in patients with severe lower limb arterial disease. This technique demonstrates comparable investigation times and procedural success rates to the femoral approach.
Area of Science:
- Cardiovascular Interventions
- Vascular Access Techniques
- Interventional Cardiology
Background:
- Percutaneous femoral access for coronary angiography is standard but challenging in patients with advanced lower limb arterial disease.
- The brachial approach is an alternative, but percutaneous axillary artery cannulation presents a viable option.
Purpose of the Study:
- To evaluate the multicenter experience and safety of percutaneous axillary artery cannulation for coronary angiography.
- To compare the axillary approach with traditional femoral and brachial methods in specific patient populations.
Main Methods:
- A multicenter study involving 120 patients undergoing coronary angiography via percutaneous axillary artery cannulation.
- Utilized standard coronary catheters and sheaths, preferentially accessing the left axillary artery (78% of cases).
Main Results:
- Successful axillary artery cannulation in all patients with no observed complications during or after the procedure.
- The left axillary approach facilitated easier catheterization of coronary ostia and bypass grafts.
- Axillary approach offers advantages including equivalent investigation time to femoral access, potential for simultaneous bi-plane imaging, and preference for arterial puncture over arteriotomy.
Conclusions:
- Percutaneous axillary artery cannulation is a safe and effective alternative for coronary angiography in patients unsuitable for femoral access.
- The technique is associated with high success rates and minimal complications, offering distinct advantages over brachial arteriotomy.
- Axillary approach may also be suitable for percutaneous transluminal coronary angioplasty procedures.
Abstract:
Coronary angiography by the percutaneous femoral approach is widely used. This technique is potentially dangerous or impossible in patients with advanced arterial disease of the lower limbs, whether or not surgically treated. In these cases, percutaneous left or right axillary approach is an alternative to brachial approach. In this article, we report our multicenter experience involving 120 patients. The left axillary artery was used in 94 cases (78%) and the right in 26 cases (22%). We used performed coronary catheters usually associated with the femoral approach. The left axillary artery was used preferentially since this avoids catheterization of the innominated trunk and allows easier catheterization of the coronary ostia and aortic ends of aorto-coronary bypass grafts. The routine use of a sheath (arterial introducer) avoided arterial compression during catheterization, prevented hemorrhagic suffusion when the catheters were exchanged, and reduced the risk of thrombosis or laceration of the axillary artery. There were no failures in the catheterization of the axillary artery and no complication was observed during or after the procedure. Axillary percutaneous technique appears to have the following advantages over the brachial arteriotomy: 1) Investigation time is equivalent to the time needed for the femoral percutaneous approach. 2) There is the possibility of lateral and simultaneous bi-plane angiograms. 3) Arterial puncture is preferable to arteriotomy. The axillary approach could also be used for percutaneous transluminal coronary angioplasty.