**3.3 Technique**


**9**

*Different Sites of Vascular Access for Transcutaneous Aortic Valve Implantation (TAVI)*

The subclavian artery has recently become a site of access for TAVI [7]. Right axillary or subclavian artery is rarely used for TAVI because of anatomic restrictions and unfavourable angle for valve implantation. The proximal third of the left axillary artery (between the lateral border of the first rib and the medial border of the pectoralis minor) represents the ideal target for both surgical and percutaneous

A study suggested that subclavian access is not advisable in patients with subclavian artery diameter <7 mm, significant tortuosity, or prior coronary artery bypass

There is a higher risk of stroke due to interruption of blood flow to the vertebral arteries in patients with carotid disease who depend on the vertebral arteries for

• CT angio scan with 3D reconstruction of the subclavian and axillary arteries.

• It is more prone for vascular complications (especially in old age) because of anatomical differences between subclavian/axillary (more elastic fibers and

• Post CABG patients in whom LIMA was used for LAD anastomosis, this

• A femoral artery and vein access is obtained, 6 Fr sheath is inserted and then pigtail catheter is placed in the aortic sinus and a femoral transvenous tempo-

• Surgical cutdown for the left axillary artery is done in deltopectoral groove (6–7 cm in size and 1 cm below and parallel to the clavicle from the mid

• Axillary artery is exposed by dissection of pectoralis major and lateral retrac-

• Vessel size should be >6.5 mm without calcifications and tortuosity

less muscular wall) and femoral arteries.

approach can be lethal due to acute graft occlusion.

rary pacing lead inserted through femoral vein.

clavicular line to the axillary line) (**Figure 3**)

• Purse string suture is placed on the artery

• The patient is heparinized to maintain an ACT 200–250 s

• A sheath is inserted by direct puncture Using the Seldinger technique

tion of the pectoralis minor

grafting (CABG) and patent in situ internal mammary artery grafts [8].

*DOI: http://dx.doi.org/10.5772/intechopen.84533*

**4. Transsubclavian/axillary access**

**4.1 Introduction**

approaches.

**4.2 Disadvantages**

cerebral perfusion.

**4.3 Planning**

**4.4 Technique**

• We usually extubate the patient in operating room
