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Deploying Mechanical Circulatory Support Via the Axillary Artery in Cardiogenic Shock and High-Risk Percutaneous Coronary Intervention.
- Source :
-
The American journal of cardiology [Am J Cardiol] 2020 Aug 01; Vol. 128, pp. 127-133. Date of Electronic Publication: 2020 May 19. - Publication Year :
- 2020
-
Abstract
- We sought to study the feasibility of axillary artery as alternative access for mechanical circulatory support (MCS) in cardiogenic shock and high-risk percutaneous coronary intervention (HR-PCI) patients with severe occlusive peripheral artery disease (PAD). In patients with severe PAD, the iliofemoral artery may be so diseased preventing deployment of MCS, precluding the use of lifesaving therapy. In such circumstances, the axillary artery may be a viable access site. Records of all patients presenting with cardiogenic shock or HR-PCI requiring MCS through axillary artery access at our institution from January 2016 to September 2018 were examined. Demographics, clinical, procedural, and outcomes data were collected on all patients. A total of 48 patients presented with cardiogenic shock (60%) or HR-PCI (40%) requiring MCS via axillary artery due to prohibitive PAD (mean age 66 ± 11 years). Admission diagnoses were non-ST segment elevation myocardial infarction (38%), unstable angina (23%), ST segment elevation myocardial infarction (19%), and cardiac arrest (21%). Time from axillary access to activation of Impella was 11.9 ± 4 minutes. Four patients required concomitant Impella RP for right ventricular support due to biventricular cardiogenic shock. Twenty-two patients died before Impella was explanted due to multiorgan failure, stroke, and infection. None of the patients who died had vascular complications related to axillary access. Axillary artery appears to be a viable alternative access for large bore devices in patients with prohibitive PAD. As experience of the field with this approach grows, it may be the default access for deployment of large bore sheaths in the future.<br /> (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Angina, Unstable complications
Feasibility Studies
Female
Femoral Artery
Heart Arrest complications
Humans
Iliac Artery
Male
Middle Aged
Non-ST Elevated Myocardial Infarction complications
Peripheral Arterial Disease complications
Retrospective Studies
ST Elevation Myocardial Infarction complications
Shock, Cardiogenic etiology
Stroke Volume
Young Adult
Angina, Unstable therapy
Axillary Artery
Heart Arrest therapy
Heart-Assist Devices
Non-ST Elevated Myocardial Infarction therapy
Percutaneous Coronary Intervention methods
ST Elevation Myocardial Infarction therapy
Shock, Cardiogenic therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1913
- Volume :
- 128
- Database :
- MEDLINE
- Journal :
- The American journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 32650906
- Full Text :
- https://doi.org/10.1016/j.amjcard.2020.04.039