Related Experiment Video
Updated: Mar 8, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Portico Sheathless Transcatheter Aortic Valve Implantation via Distal Axillary Artery
Giuseppe Bruschi1, Paola Colombo1, Luca Botta1
1"De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Milan, Italy.
Insights
Transcatheter aortic valve implantation offers a minimally invasive option for severe aortic stenosis in high-risk patients. A novel distal axillary artery approach was successfully used when the standard transfemoral route was not feasible.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Transcatheter aortic valve implantation (TAVI) is a key treatment for severe aortic stenosis in elderly, high-risk surgical patients.
- The transfemoral retrograde approach is the preferred, minimally invasive TAVI method, often performed under local anesthesia.
- Severe peripheral artery disease can contraindicate the transfemoral approach, necessitating alternative access routes.
Observation:
- This report details the first use of the Portico transcatheter aortic valve implantation system via the distal axillary artery.
- The procedure was performed on a 90-year-old patient with severe aortic stenosis and contraindications for the transfemoral route.
Findings:
- Successful implantation of the Portico TAVI system was achieved through the distal axillary artery.
- This demonstrates the feasibility of an alternative TAVI access route in complex peripheral artery disease cases.
Implications:
- The distal axillary artery approach provides a viable alternative for TAVI when transfemoral access is compromised.
- This expands treatment options for severe aortic stenosis patients with challenging vascular anatomies.
- Further research into axillary artery TAVI may broaden patient eligibility for this life-saving procedure.
Abstract:
Transcatheter aortic valve implantation has been designed to treat older patients affected by severe aortic stenosis who are considered high-risk surgical candidates because of multiple comorbidities. The least invasive approach for transcatheter aortic valves implantation should be considered the transfemoral retrograde route, because it is minimally invasive and is feasible with local anesthesia and mild sedation. Despite significant technical improvements in recent years, the transfemoral approach is contraindicated in cases of severe peripheral artery disease. We describe the first case of a Portico transcatheter aortic valve implantation system (St. Jude Medical, Minneapolis, MN) made through the distal axillary artery in a 90-year-old patient affected by severe aortic stenosis.
