Transfemoral access remains the preferred route for TAVR in patients with peripheral artery disease, associated with lower mortality and complication rates compared to alternative approaches.
Does transfemoral access reduce mortality and complications compared to alternative routes in TAVR patients with peripheral artery disease?
Transfemoral access, aided by advanced pre-procedural planning and vessel preparation, remains the safest and preferred route for TAVR in patients with peripheral artery disease.
ABSTRACT Transcatheter aortic valve replacement (TAVR) is the preferred treatment for severe aortic stenosis (AS) in high‐risk surgical patients. The transfemoral (TF) access is the gold standard due to its minimally invasive nature and favorable outcomes. However, peripheral artery disease (PAD), common in TAVR candidates, can complicate TF access due to calcification, tortuosity, and vessel narrowing. This literature review evaluates vascular access strategies for TAVR in patients with PAD, highlighting recent advances that support expanded use of TF access. A narrative literature review was conducted in scientific databases up to 14 April 2025. Studies reporting on access strategies for TAVR in patients with PAD were included. The SANRA scale was utilized to ensure methodological quality. TF access remains the preferred route for TAVR, associated with lower mortality and complication rates compared to alternative approaches. Tools like the Hostile Score has further strengthened pre‐procedural planning by quantifying iliofemoral complexity and helping clinicians determine the safest and most feasible access route. Advances in technology have enhanced TF feasibility in patients with PAD, enabling device delivery despite complex anatomy. When TF access is not viable, alternative routes remain feasible but are linked to increased risks, including stroke and vascular complications. Expanding the eligibility for TF access through vessel preparation and imaging‐guided planning can improve safety and outcomes in PAD patients undergoing TAVR. A personalized approach based on anatomy feasibility, supported with risk stratification tools and multidisciplinary collaboration is essential to selecting the optimal vascular access strategy.
Aufazhafarin et al. (Mon,) conducted a review in Severe aortic stenosis and peripheral artery disease. Transfemoral access vs. Alternative access routes was evaluated. Transfemoral access remains the preferred route for TAVR in patients with peripheral artery disease, associated with lower mortality and complication rates compared to alternative approaches.
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