Graft-free surgical retroperitoneal vascular access as bail-out technique for failed percutaneous approach to transcatheter aortic valve replacement.

MedStar author(s):
Citation: Cardiovascular Revascularization Medicine. 14(1):23-6, 2013 Jan-Feb.PMID: 23337381Institution: MedStar Heart & Vascular Institute | MedStar Washington HospitalDepartment: Surgery/Vascular SurgeryForm of publication: Journal ArticleMedline article type(s): Comparative Study | Journal Article | Video-Audio MediaSubject headings: *Aortic Valve Stenosis/th [Therapy] | *Cardiac Catheterization | *Femoral Artery | *Heart Valve Prosthesis Implantation/mt [Methods] | *Iliac Artery | Aged | Aged, 80 and over | Aortic Valve Stenosis/su [Surgery] | Cardiac Catheterization/ae [Adverse Effects] | Chi-Square Distribution | Female | Femoral Artery/ra [Radiography] | Heart Valve Prosthesis Implantation/ae [Adverse Effects] | Humans | Iliac Artery/ra [Radiography] | Male | Punctures | Radiography, Interventional | Retroperitoneal Space/su [Surgery] | Retrospective Studies | Severity of Illness Index | Time Factors | Treatment FailureYear: 2013Local holdings: Available in print through MWHC library: 2002 - presentISSN:
  • 1878-0938
Name of journal: Cardiovascular revascularization medicine : including molecular interventionsAbstract: BACKGROUND: Surgical retroperitoneal access to the iliac artery may provide an alternative route for transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis and prohibitively small common femoral arteries.CONCLUSIONS: Surgical retroperitoneal access is a reasonable alternative for transcatheter aortic valve replacement in high-risk patients with aortic stenosis who have poor percutaneous access options due to peripheral vascular disease. Copyright 2013. Published by Elsevier Inc.METHODS: Consecutive patients undergoing TAVR via the femoral approach were divided into two groups; standard percutaneous access (n=103) and surgical retroperitoneal access (n=15) for patients in whom dilators could not be advanced without resistance. For retroperitoneal access, proximal groin vessels were exposed surgically and direct puncture was performed. The sheath was tunneled from the level of the initial inguinal puncture site in order to achieve coaxial entry of the sheath into the vessel.RESULTS: Baseline characteristics were similar in both groups. Procedural characteristics were insignificantly different between groups; although, procedure time was longer (34 min), while fluoroscopy time and contrast utilization were lower in the retroperitoneal access group. There was no outcome difference between groups.All authors: Akbari C, Barbash IM, Beavers F, Ben-Dor I, Dvir D, Momin T, O'Donnell S, Okubagzi P, Pichard AD, Ricotta J, Satler LF, Waksman RFiscal year: FY2014Digital Object Identifier: Date added to catalog: 2014-04-22
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 23337381 Available 23337381

Available in print through MWHC library: 2002 - present

BACKGROUND: Surgical retroperitoneal access to the iliac artery may provide an alternative route for transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis and prohibitively small common femoral arteries.

CONCLUSIONS: Surgical retroperitoneal access is a reasonable alternative for transcatheter aortic valve replacement in high-risk patients with aortic stenosis who have poor percutaneous access options due to peripheral vascular disease. Copyright 2013. Published by Elsevier Inc.

METHODS: Consecutive patients undergoing TAVR via the femoral approach were divided into two groups; standard percutaneous access (n=103) and surgical retroperitoneal access (n=15) for patients in whom dilators could not be advanced without resistance. For retroperitoneal access, proximal groin vessels were exposed surgically and direct puncture was performed. The sheath was tunneled from the level of the initial inguinal puncture site in order to achieve coaxial entry of the sheath into the vessel.

RESULTS: Baseline characteristics were similar in both groups. Procedural characteristics were insignificantly different between groups; although, procedure time was longer (34 min), while fluoroscopy time and contrast utilization were lower in the retroperitoneal access group. There was no outcome difference between groups.

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