From the Guidelines
The axillary artery is a viable option for arterial line placement when carotid access is not possible, as it provides reliable blood pressure monitoring and arterial blood sampling with a lower risk of cerebral complications. The axillary artery, located in the axilla (armpit) region, is a large vessel with good collateral circulation, making it a suitable alternative site for arterial line placement 1. To place an axillary arterial line, position the patient's arm abducted at 90 degrees with external rotation, and palpate the artery in the axillary fossa. Use a 20G catheter with standard Seldinger technique under ultrasound guidance when possible.
Some key considerations for axillary artery cannulation include:
- The axillary site offers several advantages, including a lower risk of cerebral complications compared to carotid access, and can be more comfortable for conscious patients 1.
- However, be aware of potential complications including hematoma formation, nerve injury (particularly to the brachial plexus), and thrombosis.
- The site may be more difficult to secure and maintain, especially in agitated patients.
- Other alternative sites to consider include femoral, brachial, radial, and dorsalis pedis arteries, each with their own risk-benefit profiles based on the clinical situation.
In terms of specific guidelines, the 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery recommend the use of the axillary-subclavian artery for cannulation, especially in aortic dissection, as it permits antegrade flow in the arch vessels and is usually free from atherosclerosis with rich, collateral vessels to the distal arm 1. Additionally, a study published in 2016 notes that right or left axillary artery cannulation can be performed when the femoral system is not suitable for arterial inflow 1.
From the Research
Arterial Line Placement Options
- The axillary artery can be considered as an alternative access site for arterial line placement when carotid (common carotid artery) access is not possible 2, 3, 4.
- Studies have shown that axillary artery access is a safe and effective option for large-bore interventions, with a low risk of complications 2, 3.
- Ultrasound-guided axillary artery catheter placement has been found to be a viable alternative in patients where radial or femoral arterial access is difficult or not possible 3.
Comparison with Carotid Access
- Carotid artery access has been used as an alternative to transfemoral, transaxillary, or transapical aortic valve implantation in some patients 5.
- However, axillary artery access may be preferred in certain cases due to its lower risk of complications and easier accessibility 2, 4.
- A case study has reported the use of carotid access with axillary-carotid bypass for descending aortic aneurysm repair, highlighting the potential for combined approaches 6.
Considerations for Axillary Artery Access
- The axillary artery is rarely atherosclerotic, making it a suitable option for large-bore interventions 2.
- Ultrasound-guided axillary artery catheter placement can help minimize the risk of complications, such as bleeding and vascular complications 3.
- The use of axillary artery access may require additional skill sets and equipment, as well as multidisciplinary teams to ensure safety and success 4.