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Updated: Aug 8, 2025

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Transcaval Access and Closure Best Practices.

Robert J Lederman¹, Adam B Greenbaum², Jaffar M Khan³

¹Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.

JACC. Cardiovascular Interventions

|March 1, 2023

Summary

This summary is machine-generated.

Transcaval aortic access offers a safe method for large arterial access, decompressing safely into the vena cava. This review details techniques for transcatheter aortic valve replacement and aneurysm repair.

Keywords:

TAVR TEVAR mechanical circulatory support nonfemoral access transcaval vascular access

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Area of Science:

Vascular Surgery
Interventional Cardiology
Medical Device Technology

Background:

Transcaval aortic access is an electrosurgical technique for large-bore arterial access via the inferior vena cava.
Its safety is attributed to pressure differentials allowing harmless decompression of arterial bleeding into the vena cava.
Established use in transcatheter aortic valve replacement and endovascular aneurysm repair, with potential in percutaneous mechanical circulatory support.

Purpose of the Study:

To review contemporary best practices for transcaval access and closure techniques.
To address the limitations in device availability hindering wider adoption.
To provide guidance on patient selection, planning, technique, and complication management.

Main Methods:

State-of-the-art review of transcaval access and closure procedures.
Detailed description of exemplary techniques, including computed tomographic planning.
Guidance on step-by-step access, closure, complication management, and troubleshooting.

Main Results:

Transcaval access is a viable alternative to other approaches when transfemoral access is suboptimal.
The technique has been successfully applied in thousands of patients for various cardiovascular interventions.
Dissemination has been limited by the lack of commercially available dedicated devices.

Conclusions:

Transcaval access is a versatile and safe technique for large-bore arterial access.
Standardized best practices can enhance operator proficiency and facilitate wider adoption.
Further development of dedicated devices is crucial for broader clinical implementation.