A patient is described having severe aortic stenosis and severe pulmonary disease contraindicating general anaesthesia for standard surgical aortic valve replacement as well as Transcatheter Aortic Valve Implantation (TAVI) using apical or direct aortic access. Dimensions of femoral and subclavian arteries were prohibitive for vascular access for TAVI. Therefore, the patient was treated by TAVI under full consciousness in spinal anaesthesia using a conduit to the common iliac artery. Thus, this case describes an alternative access route and anaesthesiological handling in otherwise untreatable TAVI candidates.
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