title: Bending the Rules in Transfemoral TAVI With the SAPIEN 3: Overcoming Severe Iliac Tortuosity.
abstract: Whilst the worldwide uptake of transcatheter aortic valve implantation (TAVI) over the last 10 years has been dramatic, iliac tortuosity remains a potential barrier to the most commonly chosen access route via the femoral artery. We describe the challenges posed by severe iliac tortuosity during transfemoral TAVI and contrast a difficult procedure - at the limit of the capability of current device delivery technology - with a straightforward implantation. The use of pre-procedural multi-detector computed tomography to assess the vasculature and a bilateral stiff wire technique for managing iliofemoral tortuosity are discussed.
authors.affiliation: Deutsches Herzzentrum München, Munich, Bavaria, Germany. Electronic address: jmresearch2013@gmail.com.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Michel
authors.affiliation: Deutsches Herzzentrum München, Munich, Bavaria, Germany.
authors.forename: Antonio H
authors.initials: AH
authors.lastname: Frangieh
authors.affiliation: Deutsches Herzzentrum München, Munich, Bavaria, Germany.
authors.forename: Ilka
authors.initials: I
authors.lastname: Ott
authors.affiliation: Deutsches Herzzentrum München, Munich, Bavaria, Germany.
authors.forename: A M
authors.initials: AM
authors.lastname: Kasel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging*; D008297:Male; D061330:Multidetector Computed Tomography; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*
keywords: Iliac tortuosity; MDCT; SAPIEN 3; TAVI