SCAI Position Statement Addresses Percutaneous Transaxillary Arterial Access and Training

April 19, 2022—The Society for Cardiovascular Angiography & Interventions (SCAI) announced the publication of a position statement providing evidence-based recommendations for percutaneous transaxillary arterial access and training for clinicians. The document was endorsed by the American College of Cardiology, Heart Failure Society of America, Society of Interventional Radiology, and Vascular & Endovascular Surgery Society.

The full position statement by Arnold H. Seto, MD, et al is available online in Journal of the Society for Cardiovascular Angiography & Interventions.

Dr. Seto, who is the writing group Chair, commented in the SCAI press release, “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.” Dr. Seto is from Long Beach VA Medical Center in Long Beach, California.

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

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, noted the SCAI press release.

The society further stated that a formal SCAI statement regarding the axillary artery route was warranted to inform clinicians on best practices and guide future training options.

The background of the statement, as summarized by SCAI, is that 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 because of previous surgical interventions, disease, or other health issues. In these situations, axillary artery access can be a more feasible and beneficial alternative. Because of its benefits, usage of the transaxillary approach is progressively increasing.

David A. Baran, MD, who is Cochair of the writing group, commented in the SCAI press release, “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.” Dr. Baran is from the Cleveland Clinic Heart, Vascular and Thoracic Institute in Weston, Florida.