SCAI issues position paper on transaxillary arterial access

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Darren B. Schneider

The Society for Cardiovascular Angiography & Interventions (SCAI) has released an official position statement providing evidence-based recommendations for percutaneous transaxillary arterial access and training for clinicians. The document was published in the Journal of the Society for Cardiovascular Angiography & Interventions (JSCAI), with Society for Vascular Surgery (SVS) representative Darren B. Schneider, MD, and Vascular and Endovascular Surgery Society (VESS) representative Yazan Duwayri, MD, co-authors.

The femoral artery is the most frequent access site for percutaneous placement of large-bore arterial sheaths and devices. However, transfemoral access may be limited in a specific group of patients due to prior surgical interventions, disease, or other health issues. In these situations, axillary artery access can be a more feasible and beneficial alternative. Due to its benefits, usage of the transaxillary approach is progressively increasing. A formal SCAI statement regarding this access route was warranted to inform clinicians on best practices and guide future training options, the organization said.

“With the increasing use of percutaneous temporary mechanical circulatory support options for patients with cardiogenic shock, a wide range of specialists will need to be familiar with these concepts including advanced heart failure, interventional cardiology, and cardiothoracic and vascular surgery,” said David A. Baran, MD, of the Cleveland Clinic Heart, Vascular and Thoracic Institute, Weston, Florida, co-chair of the writing group.

The expert consensus statement aims to review the anatomic considerations and risks for percutaneous axillary artery access, suggest best practices for access techniques, hemostasis/closure strategies, and complication management.

“Axillary access is the predominant ‘alternative site’ for large-bore structural and endovascular procedures, and fortunately is less frequently affected by atherosclerosis. However, it is less muscular and more prone to injury than the femoral artery and potentially poses some unique risks to the unfamiliar operator. We brought together interventional cardiologists, vascular surgeons, interventional radiologists, and heart failure specialists to share their best practices for this important technique, including anatomy, positioning, ultrasound guidance, dry closure, and complication management,” said Arnold H. Seto, MD, Long Beach VA Medical Center, Long Beach, California, writing group chair.

The statement concludes with recommendations for areas to explore in the future such as imaging for axillary access, approaches to axillary device removal, and securing devices for longer term use. There is also a strong emphasis on the importance of developing training criteria and requirements, and privileging considerations.

The document was endorsed by the American College of Cardiology (ACC), Heart Failure Society of America (HFSA), Society for Interventional Radiology (SIR), and VESS.

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