title: Transcatheter aortic valve implantation when classical access routes are unavailable.
abstract: A 90-year-old woman with symptomatic degenerative aortic stenosis had a logistic Euroscore greater than 53.29%, indicating a high surgical risk. She was therefore advised to undergo transcatheter aortic valve implantation. Both iliac arteries showed subocclusive calcifications, and the left subclavian artery was narrow and calcified. The left common carotid (LCC) artery was chosen as the access route. After surgical exposure of the LCC artery, the Corevalve Revalving 29-mm bioprosthesis was implanted successfully. No access-site complications occurred. In our experience, a substantial proportion of elderly patients have vascular lesions precluding use of the femoral route. Brachiocephalic access routes may be valuable when no other options are available.
authors: Department of Interventional Cardiology Unit, Henri Mondor University Hospital, Val-de-Marne University, Creteil, France. gauthier.mouillet@hmn.aphp.fr
authors: Gauthier
authors: G
authors: Mouillet
authors: Pascal
authors: P
authors: Desgranges
authors: Emmanuel
authors: E
authors: Teiger
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000628:therapy*; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D003251:Constriction, Pathologic; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D016015:Logistic Models; D011474:Prosthesis Design; D015641:Radiography, Interventional; D018570:Risk Assessment; D012307:Risk Factors; D013348:Subclavian Artery / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000150:complications* / Q000000981:diagnostic imaging