1. Transradial-Guided Percutaneous Transaxillary Intra-aortic Balloon Pump Insertion 
Samual Hayman, MBBS, MSc, FRACP, Shahar Lavi, MD, FRCPC, FACC, Ryan Davey, MD, FRCPC, FACC, Sabe De, MD, FRCPC, FASE, Stuart Smith, MD, FRCPC, Rodrigo Bagur, MD, PhD, FAHA 
Canadian Journal of Cardiology 
Volume 34, Issue 1, Pages 92.e5-92.e7 (January 2018)
DOI: /j.cjca
Copyright © 2017 Canadian Cardiovascular Society Terms and Conditions

2. Figure 1
(A) Axillary angiography at the level of the medial humeral head (large arrow) using a 4F pigtail catheter (small arrow) through a left radial artery access. The optimal puncture site is in the third portion of the axillary artery (dashed lines) proximal to the subscapular artery (arrowhead). This zone comprises the inferior border of the pectoralis minor muscle and the inferior border of the teres major muscle where it becomes the brachial artery. (B) Entry to the skin close to the chest wall and below the pectoralis minor muscle. The trajectory of the micropuncture needle is assessed through external compression of the pigtail catheter (inset). (C) Pigtail catheter (arrow) for precise micropuncture target guidance (dashed arrow). Inset highlights the micropuncture wire (arrowhead) entering the vessel. (D) Intra-aortic balloon pump (IABP) positioned (thick arrow highlights proximal end of the IABP) and counterpulsation initiated (thin arrow highlights the balloon inflated). (E) Sheathless insertion (black arrow) and secured to lateral chest wall. (F) Radial sheath removed and compression band applied (arrow).
Canadian Journal of Cardiology  , 92.e5-92.e7DOI: ( /j.cjca )
Copyright © 2017 Canadian Cardiovascular Society Terms and Conditions