Preface

This book examines the contemporary methodology and management of vascular access for multiple purposes, including coronary intervention, dialysis, and transcatheter aortic valve implantation technology. It recognizes the impact of decision-making regarding the route of access to minimize procedural complications, especially in patients with complicated vascular anatomy. It also presents a method for regional anesthesia for vascular access surgery in the context of optimal clinical outcomes. A hybrid vascular surgery technique is also disputed. In addition, the book contains studies that address the need to reduce in-hospital clinical risk and boost long-term survival in patients who are candidates for vascular access surgery. Likewise, this book contains an assortment of discussions on the various clinical aspects of vascular access to enrich our knowledge and understanding of the contemporary methodology and management of vascular access for a broad range of purposes. The book contains four different sections: 1. Vascular Access: Methodology and Contemporary Management; 2. Vascular Access and Reparative Surgery; 3. Vascular Access Failure; and 4. Risk Stratification in Vascular Access.

> **Dr. Alexander E. Berezin** Professor, Senior Consultant of the Therapeutic Unit, Internal Medicine Department, State Medical University of Zaporozhye, Ukraine

**1**

Section 1

Vascular Access:

Methodology and

Contemporary

Management

Section 1

Vascular Access: Methodology and Contemporary Management

**3**

valve.

**Chapter 1**

**Abstract**

Different Sites of Vascular Access

Aortic valve stenosis is a common valvular heart disease and its incidence is increasing day by day as the life expectancy is increasing gradually. It can be of congenital or acquired variety but in old ages aortic stenosis is acquired mostly and main reasons rheumatic heart disease or senile calcification of aortic valve. Aortic valve replacement with mechanical tissue valves is the surgical management of aortic valve stenosis but some of the patients are not suitable for the surgery based on their physical status and associated comorbidities. These patients are high risk for surgical complications or they have prohibitive risks for surgery. Transcutaneous aortic valve implantation is the new technique developed to implanting aortic valve mostly without opening the sternum and without using cardiopulmonary bypass machine. This procedure is mostly done via transfemoral access but in case of contraindications to use femoral artery for access some other different accesses are used to implant the aortic valve, that is, transsubclavian/transaxillary access, transapical access, transaortic access, transcarotid and transcaval accesses. In this chapter we

**Keywords:** TAVI, transfemoral access, transsubclavian access, transaxillary access,

Aortic valve is present between left ventricle and aorta. It opens during ventricu-

Aortic stenosis (AS) represents obstruction of blood flow across the aortic valve

Most of the patients usually undergo open surgical aortic valve replacement with

due to congenital or acquired narrowing. Etiology can be bicuspid aortic valve, rheumatic aortic stenosis and senile aortic stenosis due to calcification of aortic

It is a progressive disease that presents after a long subclinical period with symptoms of decreased exercise capacity, exertional chest pain (angina), syncope,

Echocardiography helps in diagnosis and grading of the aortic stenosis

mechanical or bioprosthetic aortic valve, but some patients may not be suitable

transapical access, transaortic access, transcarotid and transcaval access

for Transcutaneous Aortic Valve

Implantation (TAVI)

*Mohd Shahbaaz Khan*

are going to discuss all accesses in details.

lar systole and closes at ventricular diastole.

**1. Introduction**

and heart failure.

(**Table 1**).
