Introduction on Overcoming the Challenges of the Transfemoral Approach in Transcatheter Aortic Valve Implantation
Since the rst human transcatheter aortic valve implantation (TAVI)performed through an antegrade transfemoral approach (i.e. femoral venous access, transseptal puncture advancement of the device to the left ventricle and antegradely through the aortic valve), the venous approach has been abandoned and different arterial access routes such as the transfemoral, transapical, subclavian or direct aortic have been developed. At present, TAVI is performed through a retrograde transfemoral approach in approximately 80-90 % of cases thanks to the improvements in delivery catheter prole, size and steerability compared with the rst generation devices. Furthermore, transfemoral TAVI has the advantage of offering the option for a fully percutaneous procedure, performed under local anaesthesia with mild sedation, via a puncture of the common femoral artery using the Seldinger technique and a closure device used with a pre-closure technique to achieve haemostasis. The aim of this review article is to describe the challenges of transfemoral TAVI and the options to overcome them. The challenges may involve either the access itself or the valve insertion and implantation.