Trans-catheter aortic-valve implantation by the subclavian approach complicated with vessel dissection and transient left-arm paralysis

Vavuranakis, Manolis; Vrachatis, Dimitrios; Filis, Konstantinos; Stefanadis, Christodoulos

doi:10.1016/j.ejcts.2010.06.003

Cited by 11 publications

(6 citation statements)

References 10 publications

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“…Another procedural concern in the percutaneous rather than the surgical cut-down approach is adequate closure of the axillary artery due to manual compression of the puncture site being anatomically challenging and often inefficient to control bleeding (5). Additionally, increased risk of neurological complication is also present with this approach due to the close proximity of the brachial plexus (50). It has also been suggested that patients with unsuitable left subclavian anatomy would not be good candidates for SC-TAVR since the right side often has an unfavorable implantation angle (42), however, right subclavian access has been successfully reported in a select number of cases (41).…”

Section: Subclavian/axillary Tavimentioning

confidence: 99%

Non-transfemoral access sites for transcatheter aortic valve replacement

Madigan¹,

Atoui²

2018

J. Thorac. Dis.

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Transfemoral access is currently the standard and preferred access site for transcatheter aortic valve replacement (TAVR), though novel approaches are emerging to expand treatment options for the increasing numbers of patients with a contraindication for the traditional route. Previous publications have provided comparisons between two TAVR access sites, primarily transfemoral versus one of the novel approaches, while others have compared three or four novel approaches. The aim of this report is to provide a comprehensive summary of publications that analyse and compare the six non-transfemoral access sites currently described in the literature. These include the transapical, transaortic, axillary/subclavian, brachiocephalic, transcarotid, and transcaval approaches. Though there remains little consensus as to the superiority or non-inferiority of TAVR approaches, and there has yet to be randomized clinical trials to support published findings, with careful patient and procedural selection, outcomes for novel approaches have been reported to be comparable to standard transfemoral access when performed by skilled physicians. As such, choice of procedure is primarily based on registry data and the judgement of surgical teams as to which approach is best in each individual case. As TAVR continues to be an increasingly widespread treatment, search for the optimal access site will grow, and focus should be placed on the importance of educating surgeons as to all possible approaches so they may review and chose the most appropriate technique for a given patient.

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Section: Subclavian/axillary Tavimentioning

confidence: 99%

Non-transfemoral access sites for transcatheter aortic valve replacement

Madigan¹,

Atoui²

2018

J. Thorac. Dis.

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“…Indeed, we have experienced two significant dissections requiring angioplasty and stenting due to the usual 90°bends in the left subclavian and aorta. Transient arm paralysis due to nerve ischemia or local tissue edema has also been reported as a potential complication [33]. The presence of a patent left internal mammary artery bypass graft is not an absolute contraindication for ipsilateral subclavian access using an 18F or even a 22F delivery system [34,35].…”

Section: Trans-subclavian Approachmentioning

confidence: 99%

Vascular access in transcatheter aortic valve implantation

Ribeiro

Vouga

Markowitz

et al. 2011

Int J Cardiovasc Imaging

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“…As the subclavian artery wall is thinner and more frail than the femoral artery, very careful handling is required to avoid vessel complications such as dissection. Furthermore, the anatomical proximity to the brachial nerval plexus requires special attention to avoid neurological complications [22]. A propensity matched study of the Italian TAVI registry demonstrated comparable procedural and 2-years results of subclavian and transfemoral TAVI [23] in 141 patients per group.…”

Section: Subclavianmentioning

confidence: 99%

Which way in? The Necessity of Multiple Approaches to Transcatheter Valve Therapy

Bleiziffer¹,

Krane²,

Deutsch³

et al. 2014

CCR

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TAVI (transcatheter aortic valve implantation) is a less invasive treatment of the stenotic aortic valve while avoiding midline sternotomy and cardiopulmonary bypass. A crimped biological valve on a self-expanding or balloon-expandable stent is inserted antegradely or retrogradely under fluoroscopy, and deployed on the beating heart. Among the worldwide TAVI programs, many different concepts have been established for the choice of the access site. Whether retrograde or antegrade TAVI should be considered the superior approach is matter of an ongoing debate. The published literature demonstrates safety of all techniques if performed within a dedicated multidisciplinary team. Since there is no data providing evidence if one approach is superior to another, we conclude that an individualized patient-centered decision making process is most beneficial, taking advantage of the complementarity of the different access options. The aim of this article is to give an overview of the current practice of access techniques for transcatheter based valve treatment and to outline the respective special characteristics.

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Trans-catheter aortic-valve implantation by the subclavian approach complicated with vessel dissection and transient left-arm paralysis

Cited by 11 publications

References 10 publications

Non-transfemoral access sites for transcatheter aortic valve replacement

Non-transfemoral access sites for transcatheter aortic valve replacement

Vascular access in transcatheter aortic valve implantation

Which way in? The Necessity of Multiple Approaches to Transcatheter Valve Therapy

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