Successful implantation and removal of Impella 5.5 device via a 4-mm subclavian artery in an adult patient

Recently, the utilization of Impella 5.5, especially in the axillary position, has increased exponentially. The device provides excellent hemodynamic support for patients in cardiogenic shock, as a bridge to recover, transplant, or durable left ventricular device. However, small size arteries remain its main limitation. With a maximum diameter of 19 Fr (6.33 mm), the recommended artery size needed for implantation is 7 mm. In this case, we discuss the successful implantation and removal of the Impella 5.5 device into a patient, with a subclavian artery diameter of 4 mm, whose other short- and mid-term options for mechanical circulatory support were limited.