Crossover Buddy Wire–Assisted Delivery of Steerable Guide Catheter

Transfemoral venous access is the standard for MitraClip procedures, but anatomic variations can hinder device delivery. An 88-year-old man with severe mitral regurgitation underwent MitraClip therapy via the right femoral vein. During the procedure, compression by a calcified right iliac artery caused severe tortuosity of the iliac vein, preventing the advancement of the steerable guide catheter. A buddy wire was introduced through a left femoral crossover approach using a Radifocus guidewire into the right iliac vein, allowing successful catheter advancement and device deployment. This case highlights the importance of adaptive strategies to overcome anatomic challenges. The buddy wire technique allows for more controlled catheter manipulation and may have reduced the risk of venous injury. The crossover buddy wire technique may be a useful bailout strategy with only minimal additional equipment to facilitate steerable guide catheter delivery in cases of venous compression.