Intra-aortic balloon pump (IABP), which augments coronary blood flow and reduces cardiac afterload, is the most widely used temporary mechanical circulatory support (TMCS) device. It has been used in a various conditions ranging from improving coronary perfusion in acute coronary syndrome and cardiogenic shock, to supporting a failing heart as a bridge to heart transplantation. With recent changes in donor heart allocation policy that favors heart transplant candidates who are on TMCS devices in the United States of America, there is a resurgence in the use of IAPB and a bridge to heart transplant. Herein we present a step-by-step surgical technique of IABP placement through Dacron graft anastomosed to the axillary artery. Under fluoroscopic guidance, the IABP catheter is advanced over the guidewire into the descending thoracic aorta. The axillary artery offers a promising alternative site to the commonly used femoral artery for the insertion of IABP as axillary IABP can be kept in longer and allows greater patient mobility. Studies indicate successful outcomes with axillary IABP, highlighting its potential advantages over femoral insertion, especially in patients awaiting heart transplantation. However, it is a surgical procedure that requires familiarity with axillary anatomy and meticulous attention to details to minimize complications.