Suggested Bony Landmarks for Safe Axillary Artery Access

To identify a fluoroscopic bony landmark for safe percutaneous axillary artery cannulation. No bony landmarks exist to guide safe percutaneous axillary artery cannulation, which is an important alternate access site for catheter-based procedures in selected patients. We retrospectively analyzed 51 consecutive percutaneous axillary artery sheath angiograms and attempted to correlate a fixed bony landmark to the proximal end of the third part of the artery. Proximal to this site, no cords of the brachial plexus traverse the anterior aspect of the vessel. Moreover, this site is proximal to the subscapular branch of the axillary artery, the first branch of its third part, and a sentinel component of the scapular anastomosis responsible for collateral blood flow to the arm. With the arm abducted at 135°, the subscapular artery originated at, or distal to, the inferior border of the glenoid cavity, as seen on fluoroscopy in the anterior-posterior projection, in all patients. The origin was within 5 mm distal to the inferior border of the glenoid cavity in 17 patients (46%), 5-10 mm in 13 patients (35%), and between 10 mm and 20 mm in 7 patients (19%). With the arm abducted, the origin of the subscapular artery correlates well with the inferior-most aspect of the glenoid cavity of the scapula under fluoroscopy. Axillary artery cannulation medial to this bony landmark typically lands the sheath in the second part or proximal end of the third part of the artery, thereby theoretically sparing injury to the brachial plexus and the subscapular artery.