**7.3 Technique**


**17**

**Figure 7.**

*Transcaval access for TAVI.*

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

The transcaval approach, described by Greenbaum et al. [18] is considered as the last resort in patients not qualifying for any other vascular access. In the transcaval approach (**Figure 7**), the delivery system is inserted through the femoral vein and crossed to the arterial system by creating an aortocaval fistula, which is closed with

A case series demonstrated the feasibility of the transcaval TAVI, revealing a successful valve deployment in 17 of 19 patients despite a 79% rate of transfusion

The location of the fistula is determined by a careful evaluation of the CT abdo-

• A baseline CT-scan to identify a calcium free target on the right abdominal aortic wall allowing for a safe passage from the inferior vena cava to the aortic

• After having obtained a femoral venous access, the inferior vena cava is

punctured by means of a stiff CTO wire mounted over a microcatheter and a

• The caval and aortic walls are perforated by using electrocautery applied at the

• Once the access is obtained to the aortic lumen, the wire is snared and both the microcatheter and the guiding catether are advanced into the abdominal aorta.

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

an Amplatzer device after the valve is deployed.

and a 33% rate of vascular complications [18].

men and pelvis prior to the procedure.

lumen of the large bore sheath

distal end of the wire.

standard RCA or IMA guiding catheter

**8. Transcaval approach**

**8.1 Introduction**

**8.2 Planning**

**8.3 Technique**
