Juan MacHannaford, MD, walks through an axillary implant of Impella 5.5. He performs all axillary procedures in a hybrid suite using a combination of fluoroscopy and transesophageal echocardiography (TEE). He describes how he gains access to the axillary artery and prepares the graft. He explains how he manages anticoagulation and discusses explant techniques and considerations. Dr. MacHannaford is section chief, cardiothoracic surgery and surgical director, heart transplantation and MCS at Medical City Heart and Spine Hospital in Dallas, TX.