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Updated: Dec 18, 2025

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Peripheral arterial disease and transcatheter valve replacement outcomes
Zvonimir Krajcer1,2, Alexander Postalian1,2
1Department of Cardiology, Texas Heart Institute, Houston, Texas, USA.
Peripheral artery disease (PAD) complicates transcatheter aortic valve replacement (TAVR) outcomes. Understanding PAD extent is crucial for TAVR planning and access site selection.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Background:
- Transcatheter aortic valve replacement (TAVR) is a key treatment for severe aortic stenosis.
- Peripheral artery disease (PAD) prevalence is significant in the TAVR population.
- PAD impacts procedural success and patient outcomes.
Discussion:
- The extent and location of PAD influence TAVR feasibility.
- Access site selection in TAVR is critically dependent on iliofemoral anatomy.
- Severe PAD may preclude standard TAVR access routes.
Key Insights:
- Patients with PAD experience poorer outcomes post-TAVR.
- PAD assessment is essential for pre-procedural planning in TAVR.
- Device delivery can be challenging in patients with extensive PAD.
Outlook:
- Further research is required to optimize TAVR in PAD patients.
- Novel strategies are needed for managing aortic and iliofemoral disease during TAVR.
- Improved treatment algorithms will enhance TAVR outcomes in complex vascular cases.
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