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Patients referred for advanced catheter-based therapies frequently have lower extremity peripheral vascular disease that is prohibitive for the use of large bore arterial catheters. Utilization of upper extremity peripheral vasculature is rarely considered as an alternative access strategy. This may be due in part to a lack of familiarity with the thoracic vasculature. We sought to describe the caliber and vascular health of the subclavian and axillary arteries as it relates to their utilization in complex cardiovascular procedures.
208 consecutive patients undergoing routine computed tomography angiograms (CTA) prior to transcatheter aortic valve replacement at a single-center were retrospectively evaluated in a systematic analysis of upper and lower extremity vasculature and standard cardiovascular risk factors.
The majority of subjects were male and Caucasian. The mean age was 80 ± 11 years, and mean BMI was 29 ± 7 kg/m2. Axillary artery minimal luminal diameters (MLDs) were 6.0 ± 1.1 mm and 6.6 ± 1.8 mm in the iliofemoral arteries. Compared to the iliofemoral arteries, the axillary arteries demonstrated significantly lower rates of significant stenosis (2% vs. 12%, p < 0.01) and significantly lower rates of moderate to severe calcification disease (9% vs. 64%, p < 0.01). Diabetes and tobacco use were independently associated with smaller axillary artery MLDs (p < 0.01) but not significant stenotic disease.
|n = 208||Minimal Luminal Diameter, mm||Moderate to Severe Calcification, n||>50% Stenosis, N|
|Proximal Axillary Artery||6.0 ± 1.1||5.9 ± 1.0||18 (9%)||17 (8%)||4 (2%)||5 (2%)|
|Distal Axillary Artery||5.6 ± 1.0||5.6 ± 0.9|
|Subclavian Artery||6.0 ± 1.1||5.8 ± 1.1||36 (18%)||45 (21%)||16 (8%)||17 (8%)|
|Innominate Artery||8.9 ± 1.8||n/a||40 (19%)||n/a||10 (5%)||n/a|
|Iliofemoral Arteries||6.6 ± 1.8||6.5 ± 1.8||137 (66%)||129 (62%)||25 (12%)||29 (14%)|
The axillary arteries are slightly smaller, but less frequently diseased than the corresponding iliofemoral vessels.
CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)