• Neil Ruparelia, Nicola Buzzatti, Vittorio Romano, Matteo Longoni, Fillipo Figini, Matteo Montorfano, Hiroyoshi Kawamoto, Tadashi Miyazaki, Pietro Spagnolo, Ottavio Alfieri, Antonio Colombo, and Azeem Latib.
• San Raffaele Scientific Institute, Milan, Italy; Imperial College, London, UK.
• Cardiovasc Revasc Med. 2015 Sep 1; 16 (6): 326-30.

ObjectivesThe aim of this study was to assess the feasibility, safety and short-term outcomes of transfemoral transcatheter aortic valve implantation (TF-TAVI) in patients with small diseased peripheral vessels.BackgroundThe transfemoral (TF) route for transcatheter aortic valve (TAVI) is the default option due to associated advantages. However, this is limited due to the high prevalence of significant peripheral arterial disease and increased risk of vascular complications.MethodsOf 539 consecutive patients undergoing TAVI in a single Italian center, 23 patients underwent TF-TAVI in the presence of small peripheral vessels as defined by a minimal luminal diameter (MLD) of ≤5.5mm [by computed tomography (CT)] and/or the inability to advance a large-bore sheath. Calcification was defined as being concentric if calcium extended more than 270° around the circumference of the artery. All patients underwent 30-day clinical follow-up.Results17 (73.9%) patients underwent peripheral vessel pre-dilatation with a semi-compliant balloon and 6 (26.1%) patients with a Solopath sheath. 6 (26.1%) patients suffered a peri-procedural complication, with 1 patient requiring surgical embolectomy for thrombotic occlusion and the remaining patients successfully managed percutaneously in the catheter laboratory. No patient suffered a vessel perforation or required implantation of a covered stent. At 30-day follow-up, all patients were free of symptoms and signs or symptoms of peripheral vascular disease, with well-functioning TAVI prostheses as evaluated by echocardiography.ConclusionsPerforming TF-TAVI is feasible in patients with no other viable vascular access option in the presence of small MLD and calcification of the peripheral vasculature, with any anticipated acute vascular complication managed in the catheter laboratory with established percutaneous techniques.Copyright © 2015 Elsevier Inc. All rights reserved.

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