A Modified Access Technique of Impella 5.0 Axillary Artery Insertion

The conventional method for the axillary artery insertion of Impella 5.0 is a nontunneling route of the side-graft. We present an alternative technique in order to facilitate device insertion and to ensure protection from potential wound contamination. The technique consists of exiting the graft separately and away from the main incision with an intact skin and subcutaneous fat between the two sites. By proper isolation of the main wound, the risk of infection can thus be largely mitigated. Furthermore, this technique allows a better landing entry angle of graft insertion; the resulting smoother curve trajectory leads to facile device insertion, while the risk of kinking after resumption of flow is readily avoided. A further possible advantage would be a less likely to produce thrombosis at the anastomosis. Differences of this technique have already been reported for insertions of extracorporeal membrane oxygenation (ECMO), and for aortic dissections and aneurysms. Our experience in 8 cases suggests the applicability of our method to access the axillary artery for Impella 5.0 insertion.