Transcaval Access to the Abdominal Aorta: indications of Interest to Surgeons and a Comprehensive Literature Review

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Aortic Interventions

Background:

• Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure for aortic valve stenosis.
• Traditional TAVI access routes include transfemoral, transsubclavian, and direct aortic access.
• The transcaval approach offers an alternative access route to the aorta, particularly relevant in complex cases.

Purpose of the Study:

• To review the literature on the indications for the transcaval approach in TAVI.
• To highlight the utility of the transcaval approach for vascular surgeons in specific scenarios.
• To summarize historical, experimental, and clinical data on transcaval access.

Main Methods:

• Literature review of studies published until August 1, 2019.
• Focus on indications, historical aspects, experimental data, case series, and outcomes.
• Analysis of technical aspects of the transcaval access route.

Main Results:

• The transcaval approach is indicated in specific cases, including endoleak treatment post-endovascular aneurysm repair (EVAR) and thoracic endovascular aneurysm repair (TEVAR).
• Historical and experimental data support the feasibility of transcaval access.
• Available case series and outcomes provide insights into its application and effectiveness.

Conclusions:

• The transcaval approach is a valuable alternative access route to the aorta for TAVI in selected patients.
• It offers a potential solution for vascular surgeons managing complications like endoleaks after EVAR and TEVAR.
• Further understanding and technical refinement of this less-common access method are beneficial.