Successful percutaneous insertion of impella device using axillary artery complicated by radial artery occlusion

Jack Xu, Hani Alturkmani, Nurredin Almaddah, John Mounsey, Gaurav Dhar, Jay Bhama, and Subhi J. Al'Aref

A 77-year-old female with a history of Peripheral Vascular Disease (PVD), Aorto Femoral Bypass (AFB), and left subclavian artery stent presented for an elective hip replacement. Her postoperative course was complicated by chest pain with inferolateral ST depressions on ECG. She was found on coronary angiogram to have an 80% calcified lesion in the proximal Left Main Coronary Artery (LM). The decision was made for percutaneous revascularization with the percutaneous placement of an Impella CP via the right axillary artery for mechanical support. Under conscious sedation, the right axillary and radial arteries were accessed under ultrasound guidance. After the Impella sheath was advanced, there was the loss of arterial waveform on the 4 Fr radial sheath. The side port of the Impella sheath was connected to the side port of the radial sheath via an extension tubing, thereby maintaining perfusion of the right hand. The percutaneous coronary intervention was performed on the LM successfully with the Impella being able to be weaned off at the end of the procedure. The present case report highlights the percutaneous utilization of the right axillary artery for mechanical circulatory support in a patient with extensive PVD as well as acute limb ischemia.