Percutaneous Axillary Artery Access for Peripheral and Complex Endovascular Interventions: Clinical Outcomes and Cost Benefits

Ann Yufa; Amarseen Mikael; Gloryanne Gautier; Joseph Yoo; Trung Duong Vo; Majid Tayyarah; Darian Behseresht; Jeffrey Hsu; Iden Andacheh

doi:10.1016/j.avsg.2021.11.027

Percutaneous Axillary Artery Access for Peripheral and Complex Endovascular Interventions: Clinical Outcomes and Cost Benefits

Ann Vasc Surg. 2022 Jul:83:176-183. doi: 10.1016/j.avsg.2021.11.027. Epub 2021 Dec 23.

Authors

Ann Yufa¹, Amarseen Mikael², Gloryanne Gautier³, Joseph Yoo³, Trung Duong Vo⁴, Majid Tayyarah⁴, Darian Behseresht⁴, Jeffrey Hsu⁴, Iden Andacheh⁵

Affiliations

¹ Albert Einstein Medical Center, Vascular Surgery, Philadelphia, PA; University of California, Riverside School of Medicine, Riverside, CA. Electronic address: annyufa92@gmail.com.
² University of California, Riverside School of Medicine, Riverside, CA; Riverside Community Hospital, Riverside, CA.
³ Albert Einstein Medical Center, Vascular Surgery, Philadelphia, PA.
⁴ Kaiser Permanente, Southern California Medical Group, Department of Surgery, Fontana, CA.
⁵ University of California, Riverside School of Medicine, Riverside, CA; Kaiser Permanente, Southern California Medical Group, Department of Surgery, Fontana, CA.

PMID: 34954376
DOI: 10.1016/j.avsg.2021.11.027

Abstract

Objectives: The aim of this study was to determine the safety, efficacy, and applicability of percutaneous axillary artery (pAxA) access in patients requiring upper extremity large sheath access during complex aortic, cardiac, and peripheral endovascular procedures. We also take this opportunity to address the potential cost-benefits offered by pAxA access compared to open upper extremity access.

Methods: A total of 26 consecutive patients, between June 2018 and October 2020, underwent endovascular intervention, requiring upper extremity access (UEA). Ultrasound-guided, percutaneous access of the axillary artery was used in all 26 patients with off-label use of pre-close technique with Perclose ProGlide closure devices. Access sites accommodated sheath sizes that ranged from 6 to 14 French (F). End points were technical success and access site-related complications including isolated neuropathies, hematoma, distal embolization, access-site thrombosis, and post-operative bleeding requiring secondary interventions. Technical success was defined as successful arterial closure intraoperatively with no evidence of stenosis, occlusion, or persistent bleeding, requiring additional intervention.

Results: Of the 26 patients requiring pAxA access, 15 underwent complex endovascular aortic aneurysm repairs (EVAR) with branched, fenestrated, snorkel, or parallel endografts, 6 underwent peripheral vascular interventions, and 5 underwent cardiac interventions. Fifty-three percent accommodated sheath sizes of 12F or higher. Technical success was achieved in 100% of cases with no major perioperative access complications requiring additional open or endovascular procedures. In our series, we had one post-operative mortality secondary to myocardial infarction in a patient with significant coronary artery disease.

Conclusions: Our data again demonstrated the proposed safety and efficacy attributable to pAxA access, while extending its application to wide spectrum of endovascular interventions which included peripheral or coronary vascular in addition to complex EVAR.

Keywords: Access; Axillary; Brachial; Percutaneous.

MeSH terms

Axillary Artery / diagnostic imaging
Blood Vessel Prosthesis Implantation* / adverse effects
Catheterization, Peripheral* / methods
Cost-Benefit Analysis
Endovascular Procedures*
Femoral Artery
Humans
Retrospective Studies
Risk Factors
Treatment Outcome