Percutaneous aortic valve replacement in patients with challenging aortoiliofemoral access

• Published in: Catheterization and cardiovascular interventions 2008-11, Vol.72 (6), p.885-890
• Main Authors: Jilaihawi, Hasan, Spyt, Tomasz, Chin, Derek, Logtens, Elaine, Laborde, Jean-Claude, Kovac, Jan
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aorta - pathology; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - pathology; Aortic Valve Stenosis - surgery; Bioprosthesis; Cardiac Catheterization - adverse effects; Catheterization, Peripheral - adverse effects; Clinical Competence; complications adult cath/intervention; Constriction, Pathologic; corevalve; Echocardiography, Doppler, Color; Female; Femoral Artery - pathology; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Humans; Iliac Artery - pathology; Male; Patient Selection; percutaneous aortic valve replacement (PAVR); percutaneous aortic valve replacement (PAVR), transcatheter aortic valve implantation; peripheral vascular disease; Peripheral Vascular Diseases - complications; Peripheral Vascular Diseases - pathology; Peripheral Vascular Diseases - surgery; Prosthesis Design; Radiography, Interventional; Risk Assessment; transcatheter aortic valve implantation; Treatment Outcome; Ultrasonography, Interventional; valvular heart disease
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.21630

Percutaneous aortic valve replacement (PAVR) offers considerable promise in treating high risk patients with aortic valve disease. Two devices are currently clinically available for transfemoral delivery: the Edwards‐Sapien balloon‐expandable bioprosthesis and the Corevalve self‐expanding bioprosthesis, both of which require careful sizing of the peripheral vasculature. Through a case based discussion, we illustrate that these limits of PAVR technology can be stretched in cases of extraordinary clinical need. We demonstrate that, following a learning curve of “optimal cases,” successful PAVR is also possible in diffusely diseased peripheries of borderline small size or with focal aortoiliofemoral disease amenable to a separate intervention beforehand. © 2008 Wiley‐Liss, Inc.