Percutaneous Axillary Artery Access: Viable Option, or Is It the Pits?

Purpose: Over the past few years, percutaneous axillary artery access (PercAx) has risen to become a viable alternative access strategy for a variety of endovascular procedures. Herein we present our approach to small and large-bore PercAx—when to use it, how to do it, how to close it, and what can go wrong. The aim of this work is to provide valuable insight into this viable percutaneous access approach, based on our experience, with careful recognition of its drawbacks and challenges.

Materials and Methods: A retrospective review and assessment of our institution’s recent experience with PercAx was conducted. Specifically, the rationale for axillary access selection, techniques for puncture, and approaches to hemostasis were studied. With respect to hemostasis techniques, we focused on the efficacy and safety of both collagen plug and suture-mediated closure devices for this access technique. Complications related to PercAx were also explored.

Results: Drivers for PercAx use included the need for large-bore (>8-Fr) access to support percutaneous hemodynamic support device implantation (in the context of iliac occlusive disease) or for visceral segment intervention in complex endovascular aneurysm repair. At our institution, we successfully placed sheaths ranging from 5 to 18 Fr for single-session endovascular treatments, in which devices were withdrawn at the conclusion of the procedures. In regard to hemostasis, both suture-mediated and collagen plug devices were used successfully. For access larger than 8 Fr, hemostasis was best achieved using dual hemostatic techniques. Complications included pseudoaneurysm formation with extravasation and acute vessel occlusion, successfully managed by endovascular means.

Conclusions: PercAx is a viable option for both small- and large-bore access when femoral access is not suitable either because of iliac occlusive disease or results in an unfavorable angle to the target vessel. Both suture mediated with adjunctive collagen plug or dual collagen plug techniques are safe and efficacious for hemostasis.