title: Percutaneous aortic valve replacement in patients with challenging aortoiliofemoral access.
abstract: Percutaneous aortic valve replacement (PAVR) offers considerable promise in treating high risk patients with aortic valve disease. Two devices are currently clinically available for transfemoral delivery: the Edwards-Sapien balloon-expandable bioprosthesis and the Corevalve self-expanding bioprosthesis, both of which require careful sizing of the peripheral vasculature. Through a case based discussion, we illustrate that these limits of PAVR technology can be stretched in cases of extraordinary clinical need. We demonstrate that, following a learning curve of "optimal cases," successful PAVR is also possible in diffusely diseased peripheries of borderline small size or with focal aortoiliofemoral disease amenable to a separate intervention beforehand.
authors.affiliation: Glenfield Hospital, Leicester, United Kingdom.
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.forename: Tomasz
authors.initials: T
authors.lastname: Spyt
authors.forename: Derek
authors.initials: D
authors.lastname: Chin
authors.forename: Elaine
authors.initials: E
authors.lastname: Logtens
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Laborde
authors.forename: Jan
authors.initials: J
authors.lastname: Kovac
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000473:pathology; D001024:Aortic Valve Stenosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects; D002406:Catheterization, Peripheral / Q000009:adverse effects; D002983:Clinical Competence; D003251:Constriction, Pathologic; D018618:Echocardiography, Doppler, Color; D005260:Female; D005263:Femoral Artery / Q000473:pathology; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D007083:Iliac Artery / Q000473:pathology; D008297:Male; D018579:Patient Selection; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000473:pathology / Q000601:surgery; D011474:Prosthesis Design; D015641:Radiography, Interventional; D018570:Risk Assessment; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional