title: A balloon-expandable sheath facilitates transfemoral TAVR in patients with peripheral vascular disease and tortuosity.
abstract: OBJECTIVE
  We sought to perform transcatheter aortic valve replacement (TAVR) via the transfemoral approach in patients with peripheral arterial disease (PAD), small caliber ileofemoral vessels and vascular tortuosity.
  
  
  BACKGROUND
  For patients with increased surgical risk, TAVR is associated with a higher 1-year survival rate than surgical aortic valve replacement (SAVR). Transfemoral vascular access for TAVR results in superior outcomes versus procedures performed via other routes in terms of mortality, morbidity and healthcare economics. In many patients, the ability to safely perform the procedure via the transfemoral approach is limited by narrow, diseased and tortuous ileofemoral vasculature.
  
  
  METHODS
  We employed the SoloPath Balloon Expandable TransFemoral Access System (Terumo Med. Corp., Tokyo, Japan) to perform transfemoral TAVR in five patients with PAD, small caliber ileofemoral vessels and vascular tortuosity.
  
  
  RESULTS
  We report our experience using this balloon-expandable sheath during 5 cases of transfemoral TAVR in patients with inhospitable ileofemoral vasculature of mean diameter ⩽ 5.8 mm. The unexpanded sheath's malleable structure and hydrophilic coating permitted deployment despite severe stenoses and tortuosity. Subsequent inflation to 18 Fr facilitated successful TAVR. Postprocedural angiography demonstrated no significant vascular access complications. In one case, the entire procedure was performed percutaneously, without common femoral artery surgical cutdown.
  
  
  CONCLUSIONS
  The SoloPath sheath system permits transfemoral TAVR in patients with PAD small caliber ileofemoral vessels and vascular tortuosity. The transfemoral balloon-expandable sheath allowed these patients to avoid the increased morbidity and mortality risks associated with direct aortic or transapical access.
authors.affiliation: Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Goldsweig
authors.affiliation: Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Osman
authors.initials: O
authors.lastname: Faheem
authors.affiliation: Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Cleman
authors.affiliation: 789 Howard Ave, Dana 3, Cardiology, New Haven, CT 06519, USA john.k.forrest@yale.edu.
authors.forename: John K
authors.initials: JK
authors.lastname: Forrest
mesh_terms: D001021:Aortic Valve / Q000503:physiopathology* / Q000637:transplantation*; D001158:Arteries / Q000002:abnormalities* / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D058729:Peripheral Arterial Disease / Q000601:surgery*; D012873:Skin Diseases, Genetic / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000601:surgery*
keywords: PAD; SoloPath; TAVR; balloon-expandable; transfemoral