Percutaneous Transaxillary Access for Large-Bore Cardiovascular Interventions: Evidence, Technique, and Complication Management.

Percutaneous transaxillary access is an established alternative to transfemoral large-bore arterial access for transcatheter structural heart interventions and mechanical circulatory support (MCS). Although useful for overcoming hostile iliofemoral anatomy and providing prolonged support and patient mobilization in case of MCS, the axillary/subclavian territory poses distinct technical and anatomical challenges that demand meticulous pre-procedural imaging, patient selection, accurate puncture under ultrasound and angiographic guidance, preservation of bailout access, and familiarity with suture-based and balloon-assisted closure strategies. This review provides a contemporary practical framework for percutaneous transaxillary access, summarizing the available clinical evidence, technical aspects of puncture and closure, complication management, and procedural tips to improve safety and reproducibility.