Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Opole, Poland.
Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland.
Sci Rep. 2024 Jan 10;14(1):1016. doi: 10.1038/s41598-024-51552-3.
Percutaneous transaxillary approach (PTAX) through the first segment of the axillary artery is not widely recognized as a safe method. Furthermore, PTAX has never been directly compared between Impella-supported percutaneous coronary interventions (Impella-PCI) and transcatheter aortic valve replacement (TAVR). This study evaluated the feasibility and safety of PTAX through the first axillary segment in Impella-PCI versus TAVR. In cases where standard imaging guidance was insufficient, a technique involving puncturing the axillary artery "on-the-balloon" was employed. The endpoints were bleeding and vascular complications, as defined by BARC and VARC-3 criteria. PTAX was successfully performed in all 46 attempted cases: 23 for Impella-PCI and 23 for TAVR. Strict adherence to BARC and VARC-3 criteria led to the frequent identification of major bleeding (57%) and a moderately frequent diagnosis of vascular complications (17%). These incidences were primarily based on post-procedural hemoglobin reduction (> 3 g/dl) but not overt bleeding. The Impella group exhibited a higher rate of BARC 3b bleeding due to a greater hemoglobin decline resulting from the prolonged implant duration and PCI itself. Left axillary access was linked to smaller blood loss. Bleeding and vascular complications, as per BARC and VARC-3 definitions, did not affect short-term prognosis, with only 3 Impella patients succumbing to heart failure unrelated to the procedures during one-month follow-up period.
经腋动脉第一段行经皮穿刺（PTAX）并未被广泛认为是一种安全的方法。此外，经皮冠状动脉介入治疗（PCI）中使用 Impella 支持与经导管主动脉瓣置换术（TAVR）之间从未直接比较过 PTAX。本研究评估了在 Impella-PCI 与 TAVR 中经腋动脉第一段行 PTAX 的可行性和安全性。在标准影像引导不足的情况下，采用了一种在“球囊上”穿刺腋动脉的技术。终点是根据 BARC 和 VARC-3 标准定义的出血和血管并发症。在所有 46 例尝试的病例中均成功进行了 PTAX：23 例用于 Impella-PCI，23 例用于 TAVR。严格遵守 BARC 和 VARC-3 标准导致主要出血（57%）和中等频率的血管并发症（17%）的频繁诊断。这些发生率主要基于术后血红蛋白降低（>3g/dl），而不是明显出血。由于植入时间延长和 PCI 本身导致血红蛋白下降更大，Impella 组的 BARC 3b 出血发生率更高。左腋动脉入路与出血量较小相关。根据 BARC 和 VARC-3 定义的出血和血管并发症并未影响短期预后，只有 3 例 Impella 患者在一个月的随访期间因与手术无关的心衰而死亡。
