Why the study?
Femoral artery caliber or disease precludes vascular access in a significant minority of candidates for transcatheter aortic valve replacement or aortic endograft therapy.
Does caval-aortic access from the inferior vena cava allow safe introduction of large-caliber sheaths and subsequent closure in a swine model?
Does caval-aortic access from the inferior vena cava allow safe introduction of large-caliber sheaths and subsequent closure in a swine model?
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“the venous system is lower pressure than the surrounding tissue,... so if you have a hole in both the aorta and a hole in the [inferior vena cava (IVC)], then the blood actually goes from the aorta to the IVC but stays intravascular. It doesn't actually bleed. So that physiologic principle allows the catheter to be withdrawn and then for a plug to be placed on the aortic side to eventually wall off the hole.”
“while the idea of transcaval access is 'jarring,' with 'very good planning' it can be 'relatively seamless' to execute.”
“This is a seminal study. It challenged conventional wisdom, which objected to the idea of safe passage between the vena cava and the aorta. More important, it is the first of many non-surgical minimally-invasive tissue-crossing, or so-called transmural catheter procedures developed at NIH that can be applied to diverse fields of medicine.”
Caval-aortic access from the IVC is a feasible and safe alternative route for large-caliber transcatheter interventions in a preclinical swine model, warranting human testing.
Femoral artery caliber or disease precludes vascular access in a significant minority of candidates for transcatheter aortic valve replacement or aortic endograft therapy. We propose an alternative access route to the abdominal aorta for large-vessel introducer sheaths by direct puncture from the adjoining inferior vena cava (IVC). We reason that the veins are larger and more compliant than corresponding arteries, that venous decompression may avert hemorrhage in confined-space arterial perforation, and that acquired aorto-caval fistulas are not immediately life-threatening. We close the caval-aortic access tract using nitinol occluders. We also test intentional failure to close the caval-aortic access tract.
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Halabi et al. (2013) studied Preclinical model for large-caliber transcatheter cardiovascular interventions (n=14). Caval-aortic access and closure was evaluated on Successful creation and closure of caval-aortic access tract.
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