Document Detail


A 'modified crossover technique' for vascular access management in high-risk patients undergoing transfemoral transcatheter aortic valve implantation.
MedLine Citation:
PMID:  22511470     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: To describe results from our 'modified crossover technique' for vascular access management during transcatheter aortic valve implantation (TAVI). BACKGROUND: Vascular access management remains a major cause of complications following TAVI due to the large bore sheaths required. METHODS: All suitable patients undergoing TAVI in our center, between June and August 2011, underwent our 'modified crossover technique,' which enables the passage of a balloon through left radial access and inflation in the proximal iliac to allow percutaneous closure in a clean field. RESULTS: In total, 15 patients were included: the logistic EuroSCORE was 19.7±12.1% and STS score 5.7±5.6%. The mean therapeutic femoral access site diameter was 8.1±1.0mm. Ten (66.7%) patients received Edwards SAPIEN™ XT (2 using the new E-sheath) and 5 (33.3%) patients a Medtronic CoreValve ReValving System® device. The 'modified crossover technique' was used successfully in all patients. There were 3 vascular complications occurring at the therapeutic access site: one rupture of the external iliac artery, one Prostar failure and one pseudoaneurysm of the right common femoral artery. All complications were successfully treated percutaneously with covered stent implantation via access from the contralateral femoral artery. In view of the balloon inflation from the left radial artery, the complications could be treated in a clean field with minimal blood loss. CONCLUSIONS: Our 'modified crossover technique' using the left radial artery as the diagnostic site for balloon inflation appears a helpful adjunct in managing TAVI vascular access sites. © 2012 Wiley Periodicals, Inc.
Authors:
Gill Louise Buchanan; Alaide Chieffo; Matteo Montorfano; Davide Maccagni; Francesco Maisano; Azeem Latib; Remo Daniel Covello; Antonio Grimaldi; Ottavio Alfieri; Antonio Colombo
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-4-18
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  -     ISSN:  1522-726X     ISO Abbreviation:  -     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-4-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Wiley Periodicals, Inc.
Affiliation:
San Raffaele Scientific Institute, Milan, Italy.
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