Related Experiment Video
Updated: Apr 10, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Alternative Aortic Access: Translumbar, Transapical, Subclavian, Conduit, and Transvenous Access to the Aorta
Jonathan D Steinberger1, Justin P McWilliams1, John M Moriarty1
1Department of Interventional Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Insights
This study explores alternative large-caliber arterial access methods for endovascular procedures when common sites are unsuitable. These techniques expand treatment options for more patients and conditions.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Techniques
Background:
- Increasing demand for large-caliber arterial access in thoracic endovascular aneurysm repair, endovascular aneurysm repair, and transaortic valve implantation.
- Anatomical and vessel size limitations often preclude the use of standard access points like the common femoral, radial, and brachial arteries.
Purpose of the Study:
- To review and present alternative arterial access strategies for endovascular interventions.
- To highlight techniques that can overcome limitations of conventional access routes.
Main Methods:
- Discussion of percutaneous access at alternative sites (subclavian, axillary, carotid).
- Overview of open surgical access to the heart (left ventricular apex) and large vessels (ascending aorta, subclavian, axillary).
- Exploration of retroperitoneal access to the iliac artery/distal aorta and novel transvenous percutaneous approaches.
Main Results:
- Alternative approaches require specialized skills, equipment, and often multidisciplinary teams.
- These methods can provide necessary large-caliber arterial access when common sites are not feasible.
Conclusions:
- The described techniques and approaches can potentially expand the reach of endovascular treatments.
- These strategies may enable treatment for a broader range of patients and complex disease states.
Abstract:
Large-caliber access to the arterial system is more frequently required in the age of thoracic endovascular aneurysm repair, endovascular aneurysm repair, and transaortic valve implantation. Frequently either anatomical or vessel size constraints preclude use of common access points such as the common femoral, radial, and brachial arteries. Alternative approaches include percutaneous access at alternate sites (subclavian, axillary, and carotid), open surgical access to the heart (left ventricular apex), open surgical access to large-caliber vessels (ascending aorta, subclavian, and axillary arteries, retroperitoneal access to the iliac artery or distal aorta), and novel percutaneous approaches (transvenous). Such approaches require additional skill sets, equipment, and, frequently, multidisciplinary teams to ensure safety and success. The techniques and approaches outlined in this article may allow expansion of endovascular treatments to greater patient populations and disease states than previously thought feasible.
