title: A "modified crossover technique" for vascular access management in high-risk patients undergoing transfemoral transcatheter aortic valve implantation.
abstract: OBJECTIVE
  To describe results from our "modified crossover technique" for vascular access management during transcatheter aortic valve implantation (TAVI).
  
  
  BACKGROUND
  Vascular access management remains a major cause of complications following TAVI due to the large bore sheaths required.
  
  
  METHODS
  All suitable patients undergoing TAVI in our center, between June and August 2011, underwent our "modified crossover technique," which enables the passage of a balloon through left radial access and inflation in the proximal iliac to allow percutaneous closure in a clean field.
  
  
  RESULTS
  In total, 15 patients were included: the logistic EuroSCORE was 19.7 ± 12.1% and STS score 5.7 ± 5.6%. The mean therapeutic femoral access site diameter was 8.1 ± 1.0 mm. Ten (66.7%) patients received Edwards SAPIEN™ XT (two using the new E-sheath) and five (33.3%) patients a Medtronic CoreValve ReValving System® device. The "modified crossover technique" was used successfully in all patients. There were three vascular complications occurring at the therapeutic access site: one rupture of the external iliac artery, one Prostar failure, and one pseudoaneurysm of the right common femoral artery. All complications were successfully treated percutaneously with covered stent implantation via access from the contralateral femoral artery. In view of the balloon inflation from the left radial artery, the complications could be treated in a clean field with minimal blood loss.
  
  
  CONCLUSIONS
  Our "modified crossover technique" using the left radial artery as the diagnostic site for balloon inflation appears a helpful adjunct in managing TAVI vascular access sites.
authors.affiliation: San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Gill Louise
authors.initials: GL
authors.lastname: Buchanan
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Davide
authors.initials: D
authors.lastname: Maccagni
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Remo Daniel
authors.initials: RD
authors.lastname: Covello
authors.forename: Antonio
authors.initials: A
authors.lastname: Grimaldi
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000209:etiology / Q000628:therapy; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000628:therapy*; D021721:Balloon Occlusion / Q000009:adverse effects / Q000295:instrumentation; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D004868:Equipment Failure; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D016015:Logistic Models; D011474:Prosthesis Design; D011677:Punctures; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000209:etiology / Q000628:therapy