Related Experiment Video
Updated: Sep 2, 2025
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Direct innominate artery access for transcatheter aortic valve replacement
Andreas R de Biasi1, Amish Raval2, Gregory Tester2
1Division of Cardiothoracic Surgery, University of Wisconsin Department of Surgery, Madison, WI, USA.
Insights
Transcatheter aortic valve replacement is challenging with hostile vascular disease. Successful valve replacement was achieved using direct innominate artery access in two patients with extensive peripheral arterial disease.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Transcatheter aortic valve replacement (TAVR) is a standard treatment for aortic stenosis.
- Access via the common femoral artery is preferred for TAVR.
- Hostile vascular disease and peripheral arterial disease can limit traditional TAVR access options.
Observation:
- Two patients presented with extensive peripheral arterial disease precluding standard TAVR access.
- These patients required alternative TAVR access strategies.
Findings:
- Successful TAVR was performed using direct innominate artery access in both patients.
- This approach provided a viable alternative when common femoral artery access was not feasible.
Implications:
- Direct innominate artery access is a feasible alternative for TAVR in select patients with complex vascular anatomy.
- This technique expands treatment options for patients with severe aortic stenosis and challenging peripheral arteries.
- Further research may explore the safety and efficacy of innominate artery access in larger cohorts.
Abstract:
Hostile vascular disease can pose a challenge for transcatheter aortic valve replacement, for which the preferred access is via a common femoral artery. However, extensive peripheral arterial disease may also preclude traditional points of alternative access in some patients. Herein, we describe two patients in whom successful transcatheter aortic valve replacement was performed via direct innominate artery access.
