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Gennari M, Biroli M, Severgnini G, Olivares P, Ferrari C, Giacari CM, Agrifoglio M, De Marco F, Taramasso M. The PIGTAIL paradigm for a fast and safe transfemoral transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2024. [PMID: 38773853 DOI: 10.1002/ccd.31090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/03/2024] [Accepted: 05/08/2024] [Indexed: 05/24/2024]
Abstract
Transfemoral transcatheter aortic valve replacement is the preferred primary access route whenever possible. Despite advancements in expertise and delivery system profiles, complications associated with the primary femoral access still significantly affect procedural morbidity and outcomes. The current standard for accurate main access planning involves proper preprocedural evaluation guided by computed tomography. Several baseline clinical and anatomical features serve as predictors for the risk of vascular injury occurring during or after transcatheter aortic valve replacement. In this paper, we aimed at reviewing the most up-to-date knowledge of the topic for a safe transfemoral access approach according to a paradigm we have called "PIGTAIL."
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Affiliation(s)
- Marco Gennari
- IRCCS Centro Cardiologico Monzino, Interventional, Valvular and Structural Heart Cardiology, Milan, Italy
| | - Matteo Biroli
- IRCCS Centro Cardiologico Monzino, Interventional, Valvular and Structural Heart Cardiology, Milan, Italy
- University of Milan, Milan, Italy
| | - Gaia Severgnini
- University of Milan, Milan, Italy
- Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Paolo Olivares
- IRCCS Centro Cardiologico Monzino, Interventional, Valvular and Structural Heart Cardiology, Milan, Italy
| | - Cristina Ferrari
- IRCCS Centro Cardiologico Monzino, Interventional, Valvular and Structural Heart Cardiology, Milan, Italy
| | - Carlo Maria Giacari
- IRCCS Centro Cardiologico Monzino, Interventional, Valvular and Structural Heart Cardiology, Milan, Italy
| | - Marco Agrifoglio
- University of Milan, Milan, Italy
- Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Federico De Marco
- IRCCS Centro Cardiologico Monzino, Interventional, Valvular and Structural Heart Cardiology, Milan, Italy
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Saraf S, Cockburn J, Alsanjari O, Hildick-Smith D. Transcatheter aortic valve implantation via the superficial femoral artery: An underused access route? Catheter Cardiovasc Interv 2018; 92:808-812. [PMID: 29481731 DOI: 10.1002/ccd.27544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/09/2018] [Accepted: 01/27/2018] [Indexed: 11/08/2022]
Abstract
Common femoral arterial (CFA) access is the most commonly used access route for transcatheter aortic valve implantation (TAVI). In majority of cases, it is easily accessible percutaneously without requiring surgical cut down. However, in patients with high body mass index (BMI) or central obesity, it can be more than 8-10 cm below the skin making the procedure more technically demanding and satisfactory hemostasis more difficult to achieve. The superficial femoral artery (SFA) lies only a few centimeters distal to the CFA with little compromise on vessel caliber, yet can allow more suitable access in certain patients with a high BMI. We describe three cases in which SFA access was successfully used as the primary delivery route for TAVI.
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Affiliation(s)
- Smriti Saraf
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, United Kingdom
| | - James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, United Kingdom
| | - Osama Alsanjari
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, United Kingdom
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, United Kingdom
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