title: Graft-free surgical retroperitoneal vascular access as bail-out technique for failed percutaneous approach to transcatheter aortic valve replacement.
abstract: BACKGROUND
  Surgical retroperitoneal access to the iliac artery may provide an alternative route for transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis and prohibitively small common femoral arteries.
  
  
  METHODS
  Consecutive patients undergoing TAVR via the femoral approach were divided into two groups; standard percutaneous access (n=103) and surgical retroperitoneal access (n=15) for patients in whom dilators could not be advanced without resistance. For retroperitoneal access, proximal groin vessels were exposed surgically and direct puncture was performed. The sheath was tunneled from the level of the initial inguinal puncture site in order to achieve coaxial entry of the sheath into the vessel.
  
  
  RESULTS
  Baseline characteristics were similar in both groups. Procedural characteristics were insignificantly different between groups; although, procedure time was longer (34 min), while fluoroscopy time and contrast utilization were lower in the retroperitoneal access group. There was no outcome difference between groups.
  
  
  CONCLUSIONS
  Surgical retroperitoneal access is a reasonable alternative for transcatheter aortic valve replacement in high-risk patients with aortic stenosis who have poor percutaneous access options due to peripheral vascular disease.
authors: Interventional Cardiology, Center for Vascular Care, MedStar Washington Hospital Center, Washington, DC, USA.
authors: Israel M
authors: IM
authors: Barbash
authors: Itsik
authors: I
authors: Ben-Dor
authors: Danny
authors: D
authors: Dvir
authors: Cameron
authors: C
authors: Akbari
authors: Petros
authors: P
authors: Okubagzi
authors: Sean
authors: S
authors: O'Donnell
authors: John
authors: J
authors: Ricotta
authors: Frederick
authors: F
authors: Beavers
authors: Takki
authors: T
authors: Momin
authors: Lowell F
authors: LF
authors: Satler
authors: Augusto D
authors: AD
authors: Pichard
authors: Ron
authors: R
authors: Waksman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects; D016009:Chi-Square Distribution; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D008297:Male; D011677:Punctures; D015641:Radiography, Interventional; D012187:Retroperitoneal Space / Q000601:surgery; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D017211:Treatment Failure