Brachial artery access for transcatheter aortic valve implantation

We describe a case of an 80-year-old male patient with symptomatic severe aortic stenosis treated with transcatheter valve implantation (TAVI). The most common and preferred type of transcatheter valve delivery is through the femoral artery. However, if transfemoral access is not possible, an altern...

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Autores principales:	Robert Topalo, Petr Hájek, Karel Vik, Radka Adlová, Milan Horn, Josef Veselka
Formato:	article
Lenguaje:	EN
Publicado:	Termedia Publishing House 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/51481f5daf314688904e12e59db7b393
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spelling	oai:doaj.org-article:51481f5daf314688904e12e59db7b3932021-12-02T17:18:42ZBrachial artery access for transcatheter aortic valve implantation1734-93381897-429510.5114/aic.2021.104782https://doaj.org/article/51481f5daf314688904e12e59db7b3932021-03-01T00:00:00Zhttps://www.termedia.pl/Brachial-artery-access-for-transcatheter-aortic-valve-implantation,35,43651,1,1.htmlhttps://doaj.org/toc/1734-9338https://doaj.org/toc/1897-4295We describe a case of an 80-year-old male patient with symptomatic severe aortic stenosis treated with transcatheter valve implantation (TAVI). The most common and preferred type of transcatheter valve delivery is through the femoral artery. However, if transfemoral access is not possible, an alternate route may be chosen. Such routes include, but are not limited to, direct aortic access, subclavian/axillary access, or transapical access, each one having their advantages and disadvantages [1, 2]. In our patient, transfemoral access was not possible due to extreme tortuosity of both pelvic arteries revealed on preoperative angiography. Computed tomography (CT) angiography was used to assess the diameter of the subclavian, axillary and brachial arteries (Figures 1 A, B). Duplex ultrasound verified the proximal diameter of the right brachial artery to be 6.7 mm (Figure 1 C). This diameter was sufficient to perform TAVI with an Evolut R 34 mm valve via the brachial artery. This approach offers multiple benefits, primarily, relatively easy access, avoidance of preparation of an artery in the otherwise very complex axillary and subclavian region, therefore decreasing chances of iatrogenic injury, and a quick recovery after the procedure. Other benefits of transbrachial delivery are usually minimal tortuosity of the arterial segment and minimal calcification. A major limitation of this approach is the diameter of the brachial artery. Other disadvantages are the same as for subclavian/axillary access and involve the angle of the aorta from the horizontal plane, as well as the unfavorable angle of valve delivery into the left ventricular outflow tract.Robert TopaloPetr HájekKarel VikRadka AdlováMilan HornJosef VeselkaTermedia Publishing HousearticleMedicineRENAdvances in Interventional Cardiology, Vol 17, Iss 1, Pp 124-125 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Robert Topalo Petr Hájek Karel Vik Radka Adlová Milan Horn Josef Veselka Brachial artery access for transcatheter aortic valve implantation
description	We describe a case of an 80-year-old male patient with symptomatic severe aortic stenosis treated with transcatheter valve implantation (TAVI). The most common and preferred type of transcatheter valve delivery is through the femoral artery. However, if transfemoral access is not possible, an alternate route may be chosen. Such routes include, but are not limited to, direct aortic access, subclavian/axillary access, or transapical access, each one having their advantages and disadvantages [1, 2]. In our patient, transfemoral access was not possible due to extreme tortuosity of both pelvic arteries revealed on preoperative angiography. Computed tomography (CT) angiography was used to assess the diameter of the subclavian, axillary and brachial arteries (Figures 1 A, B). Duplex ultrasound verified the proximal diameter of the right brachial artery to be 6.7 mm (Figure 1 C). This diameter was sufficient to perform TAVI with an Evolut R 34 mm valve via the brachial artery. This approach offers multiple benefits, primarily, relatively easy access, avoidance of preparation of an artery in the otherwise very complex axillary and subclavian region, therefore decreasing chances of iatrogenic injury, and a quick recovery after the procedure. Other benefits of transbrachial delivery are usually minimal tortuosity of the arterial segment and minimal calcification. A major limitation of this approach is the diameter of the brachial artery. Other disadvantages are the same as for subclavian/axillary access and involve the angle of the aorta from the horizontal plane, as well as the unfavorable angle of valve delivery into the left ventricular outflow tract.
format	article
author	Robert Topalo Petr Hájek Karel Vik Radka Adlová Milan Horn Josef Veselka
author_facet	Robert Topalo Petr Hájek Karel Vik Radka Adlová Milan Horn Josef Veselka
author_sort	Robert Topalo
title	Brachial artery access for transcatheter aortic valve implantation
title_short	Brachial artery access for transcatheter aortic valve implantation
title_full	Brachial artery access for transcatheter aortic valve implantation
title_fullStr	Brachial artery access for transcatheter aortic valve implantation
title_full_unstemmed	Brachial artery access for transcatheter aortic valve implantation
title_sort	brachial artery access for transcatheter aortic valve implantation
publisher	Termedia Publishing House
publishDate	2021
url	https://doaj.org/article/51481f5daf314688904e12e59db7b393
work_keys_str_mv	AT roberttopalo brachialarteryaccessfortranscatheteraorticvalveimplantation AT petrhajek brachialarteryaccessfortranscatheteraorticvalveimplantation AT karelvik brachialarteryaccessfortranscatheteraorticvalveimplantation AT radkaadlova brachialarteryaccessfortranscatheteraorticvalveimplantation AT milanhorn brachialarteryaccessfortranscatheteraorticvalveimplantation AT josefveselka brachialarteryaccessfortranscatheteraorticvalveimplantation
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Brachial artery access for transcatheter aortic valve implantation

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