Alternative Access for Transcatheter Aortic Valve Replacement: A Comprehensive Updated Review

Transfemoral is the most widely used and remains the preferred approach to perform Transcatheter aortic valve replacement (TAVR) in the vast majority of patients because of its superior clinical outcome. However, alternative access remains necessary in patients with unfavorable iliofemoral anatomy and includes peripheral strategies such as transcarotid, transaxillary, and transcaval approaches. Transcaval access offers a feasible option for patients without suitable arterial access and has shown high procedural success in contemporary studies. We hereby provide a comprehensive review on alternative access for TAVR, discussing the relevant data, providing the pros and cons of each access route.