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JACC Cardiovasc Interv. 2017 Jan 9;10(1):1-10. doi: 10.1016/j.jcin.2016.09.002.

Anatomic Suitability for Transcaval Access Based on Computed Tomography.

Author information

1
Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland. Electronic address: lederman@nih.gov.
2
Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan.
3
Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
4
Edwards Lifesciences, Irvine, California.

Abstract

Transcaval access has been used successfully for over 200 transcatheter aortic valve replacements, large-bore percutaneous left ventricular assist devices, and thoracic endovascular aortic aneurysm repairs. This review teaches how to plan transcaval access and closure based on computed tomography. The main planning goals are to: 1) identify calcium-free crossing targets in the abdominal aorta along with optimal fluoroscopic projection angles and level with respect to lumbar vertebrae; 2) identify obstacles such as interposed bowel or pedunculated aortic atheroma; 3) plan covered stent bailout; and 4) identify jeopardized vascular branches such as renal arteries that might be obstructed by bailout covered stents if employed. The aorta and inferior vena cava are segmented (sculpted) using an image reconstruction workstation and crossing targets are highlighted. Important measurements such as aortic lumen diameter and target distance from renal arteries, aortoiliac bifurcation, and right femoral vein puncture site are reported to assist the operator. The proposed classification for transcaval feasibility has been revised, making some previously unfavorable candidates now feasible or favorable based on procedural success to date. Transcaval access allows percutaneous introduction of large devices into the aorta despite small or diseased iliofemoral arteries. By following these simplified procedures, both operators and imaging specialists can easily prepare comprehensive treatment plans.

KEYWORDS:

aorto-caval; caval-aortic; computed tomography; structural heart disease; transcatheter aortic valve replacement; transcatheter electrosurgery; transcaval

PMID:
28057275
PMCID:
PMC5476938
[Available on 2017-07-09]
DOI:
10.1016/j.jcin.2016.09.002
[Indexed for MEDLINE]
Free PMC Article
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