Anatomic Suitability for Transcaval Access Based on Computed Tomography

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Medical Imaging

Background:

• Transcaval access is a proven technique for large device delivery.
• Successful applications include transcatheter aortic valve replacement (TAVR), ventricular assist devices (VADs), and thoracic endovascular aortic aneurysm repair (TEVAR).

Purpose of the Study:

• To provide a CT-based planning guide for transcaval access and closure.
• To optimize procedural success and patient selection for transcaval interventions.

Main Methods:

• Detailed CT segmentation of the aorta and inferior vena cava.
• Identification of calcium-free crossing targets and optimal fluoroscopic angles.
• Assessment for anatomical obstacles and planning of bailout strategies.

Main Results:

• Revised classification of transcaval feasibility based on recent procedural outcomes.
• Identification of critical measurements (aortic diameter, target distance) for operator guidance.
• Demonstration of transcaval access utility in patients with small or diseased iliofemoral arteries.

Conclusions:

• CT-based planning simplifies transcaval access and closure procedures.
• This approach expands candidacy for large percutaneous aortic interventions.
• Enhanced planning improves safety and efficacy for operators and imaging specialists.