title: Transfemoral transcatheter aortic valve implantation in patients with small diseased peripheral vessels.
abstract: OBJECTIVE
  The aim of this study was to assess the feasibility, safety and short-term outcomes of transfemoral transcatheter aortic valve implantation (TF-TAVI) in patients with small diseased peripheral vessels.
  
  
  BACKGROUND
  The transfemoral (TF) route for transcatheter aortic valve (TAVI) is the default option due to associated advantages. However, this is limited due to the high prevalence of significant peripheral arterial disease and increased risk of vascular complications.
  
  
  METHODS
  Of 539 consecutive patients undergoing TAVI in a single Italian center, 23 patients underwent TF-TAVI in the presence of small peripheral vessels as defined by a minimal luminal diameter (MLD) of ≤5.5mm [by computed tomography (CT)] and/or the inability to advance a large-bore sheath. Calcification was defined as being concentric if calcium extended more than 270° around the circumference of the artery. All patients underwent 30-day clinical follow-up.
  
  
  RESULTS
  17 (73.9%) patients underwent peripheral vessel pre-dilatation with a semi-compliant balloon and 6 (26.1%) patients with a Solopath sheath. 6 (26.1%) patients suffered a peri-procedural complication, with 1 patient requiring surgical embolectomy for thrombotic occlusion and the remaining patients successfully managed percutaneously in the catheter laboratory. No patient suffered a vessel perforation or required implantation of a covered stent. At 30-day follow-up, all patients were free of symptoms and signs or symptoms of peripheral vascular disease, with well-functioning TAVI prostheses as evaluated by echocardiography.
  
  
  CONCLUSIONS
  Performing TF-TAVI is feasible in patients with no other viable vascular access option in the presence of small MLD and calcification of the peripheral vasculature, with any anticipated acute vascular complication managed in the catheter laboratory with established percutaneous techniques.
authors.affiliation: San Raffaele Scientific Institute, Milan, Italy; Imperial College, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Ruparelia
authors.affiliation: San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Buzzatti
authors.affiliation: San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Romano
authors.affiliation: San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Longoni
authors.affiliation: San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Fillipo
authors.initials: F
authors.lastname: Figini
authors.affiliation: San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.affiliation: San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Kawamoto
authors.affiliation: San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Miyazaki
authors.affiliation: San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Spagnolo
authors.affiliation: San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.affiliation: San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.affiliation: San Raffaele Scientific Institute, Milan, Italy. Electronic address: info@emocolumbus.it.
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D008297:Male; D058729:Peripheral Arterial Disease / Q000150:complications* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: Peripheral access; TAVI; Transcatheter aortic valve implantation; Vascular access