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Transcaval Aortic Catheterization for Transcatheter Aortic Valve Replacement and Thoracic Endovascular Aortic Repair Device Delivery 

Transcaval Aortic Catheterization for Transcatheter Aortic Valve Replacement and Thoracic Endovascular Aortic Repair Device Delivery
Chapter:
Transcaval Aortic Catheterization for Transcatheter Aortic Valve Replacement and Thoracic Endovascular Aortic Repair Device Delivery
Author(s):

Michael D. Dake

DOI:
10.1093/med/9780199986071.003.0014
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date: 20 September 2020

During the past decade, development of catheter-based techniques for treatment of thoracic aortic and aortic valve pathologies has required that interventionalists focus on the anatomic suitability of vascular access to allow safe introduction of large size devices. Both thoracic endovascular aortic repair (TEVAR) and transcatheter aortic valve implantation (TAVI) procedures require 20 French and larger sheaths and most of major complications during these procedures have been access related. This chapter reviews transcaval aortic access techniques for delivering large devices during TEVAR and TAVI. Alternative arterial access or adjunctive femoral access techniques that increase the safety of access and reduce the overall procedural risk for patients with challenging access are critically important for the success of TEVAR or TAVI. The procedure involves transcatheter puncture of the abdominal aorta from the inferior vena cava, with delivery of a large vascular sheath and tract closure post device delivery using a nitinol occlusion device.

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