When the heart muscle is weakened, it can struggle to supply the body with enough oxygen-rich blood. A temporary heart pump, known as a percutaneous ventricular assist device, can assist the heart’s function. This small pump is temporarily placed within the heart to help it move blood, allowing the muscle to rest and recover. This support ensures the body’s organs receive the blood flow they need and can act as a bridge to recovery or other treatments.
The Axillary Approach Explained
The Impella is a specific type of temporary heart pump designed to be inserted into the body through an artery. It consists of a thin, flexible tube called a catheter with a microaxial pump at its tip. This pump is positioned across the aortic valve, pulling blood from the left ventricle—the heart’s main pumping chamber—and expelling it into the aorta. This action reduces the heart’s workload and boosts blood flow.
The “axillary approach” refers to the specific point of entry used to place the device. This procedure utilizes the axillary artery, a major blood vessel located in the shoulder and armpit area. This site is an alternative to the more conventional femoral artery approach in the groin. The axillary artery is often chosen when a patient has peripheral artery disease that makes accessing the femoral arteries difficult or risky.
Using the axillary artery provides a stable and secure access point for the pump. Because this artery is generally less affected by the hardening and narrowing associated with atherosclerotic disease, it can more easily accommodate the device sheaths. In some cases, a surgeon will attach a small tube, or graft, to the side of the artery. This graft then serves as the entry point, preserving the integrity of the artery itself.
Conditions Requiring Axillary Impella Support
Physicians use this form of mechanical circulatory support in a few high-stakes medical scenarios. One of the most common is cardiogenic shock, a life-threatening condition where the heart suddenly becomes unable to pump enough blood. This can happen after a severe heart attack or due to rapidly worsening chronic heart failure. The Impella pump can take over a significant portion of the heart’s work, restoring blood flow to vital organs.
Another primary use is during complex, high-risk percutaneous coronary interventions (PCI), more commonly known as angioplasty and stenting. These procedures are performed to open severely blocked coronary arteries. For patients with very weak heart muscle or blockages in certain locations, the procedure itself can cause dangerous drops in blood pressure. The Impella is inserted before the intervention begins, acting as a prophylactic safety net.
The device provides hemodynamic support, ensuring that blood pressure and organ perfusion remain stable while the cardiologist works on clearing the blockages. This preemptive support allows for a safer and more complete procedure. By unloading the left ventricle, the pump reduces the stress and oxygen consumption of the heart muscle during a vulnerable period. This stability gives the medical team the time needed to perform a thorough intervention.
The Implantation Process
The placement of an Impella device via the axillary artery is a procedure performed in a specialized environment known as a catheterization laboratory, or “cath lab.” The patient is given anesthesia to ensure comfort and stillness. Medical staff then use ultrasound imaging to precisely locate the axillary artery in the shoulder area, identifying the optimal point for access.
Once the location is confirmed, a small incision is made in the skin. For certain Impella models, the physician will perform a “cutdown” to directly visualize the artery and surgically attach a vascular graft to serve as the conduit. For other models, the device can be inserted percutaneously, directly through the skin into the artery using a needle and guidewire.
With access established, the Impella catheter is carefully advanced through the body’s arterial system. The journey is monitored in real-time using fluoroscopy, a type of live X-ray that allows the physician to see the catheter as it moves toward the heart. The operator guides the catheter up to the aorta, across the aortic valve, and into the final position inside the left ventricle. Once placed, the pump is activated and secured.
Patient Recovery and Ambulation
A significant benefit of using the axillary artery for insertion relates to the patient’s recovery period and their ability to be mobile. When the device is placed through the femoral artery in the groin, patients are often required to remain on strict bed rest. This is because bending at the hip could kink the catheter or cause it to move out of its precise location within the heart.
In contrast, the axillary approach frees the patient from this restriction. With the catheter secured at the shoulder, the patient’s hips and legs are free to move. This allows for “ambulation,” which is the ability to sit up, stand, and walk with assistance. Being mobile is an important factor in a patient’s recovery, especially for those who may require mechanical support for several days.
This ability to get out of bed helps prevent complications associated with prolonged immobility, such as pneumonia, blood clots in the legs, and the loss of muscle mass. Early ambulation can contribute to better clinical outcomes, reducing time spent in the intensive care unit. The patient is closely monitored until their heart function has improved enough for the device to be safely removed.