Key result
Transaxillary TAVR provides a safe, efficient, and reproducible alternative when transfemoral access is precluded.
Why the study?
Unfavorable iliofemoral anatomy can preclude transfemoral valve delivery in TAVR, necessitating consideration of alternative arterial access routes.
Transaxillary arterial access provides a safe, efficient, and reproducible alternative valve delivery route for TAVR when transfemoral access is prohibitive.
May offer alternative TAVR access via transaxillary route when iliofemoral anatomy precludes transfemoral delivery; leaves open need for outcome validation.
OBJECTIVES: Transcatheter aortic valve replacement (TAVR) valve delivery is usually achieved transfemorally. Unfavorable iliofemoral anatomy can preclude transfemoral valve delivery, and alternative arterial access should be considered. We describe our preferred technique in transaxillary TAVR. KEY STEPS: 1) Radial or femoral arterial access for pigtail catheter placement; 2) femoral venous access for temporary pacemaker placement; 3) axillary artery exposure, control, and access; 4) root aortography; 5) aortic valve crossing; 6) advancement of the valve delivery system; 7) valve deployment; and 8) removal of the valve delivery system, repair of the axillary arteriotomy, and wound closure. POTENTIAL PITFALLS: 1) Arterial access site bleeding or stenosis; 2) arterial thrombosis; 3) axillary artery dissection; and 4) significant atherosclerosis interfering with arteriotomy repair. TAKE-HOME MESSAGE: Transaxillary arterial access for TAVR is a safe alternative valve delivery route, should be considered the first alternate access choice, and provides an efficient, effective, and reproducible technique when transfemoral access is prohibitive.
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Polycarpou et al. (2026) studied Aortic valve disease requiring TAVR with prohibitive transfemoral access. Transaxillary Transcatheter Aortic Valve Replacement was evaluated. Transaxillary transcatheter aortic valve replacement is described as a safe, efficient, and reproducible alternative delivery route when unfavorable iliofemoral anatomy precludes transfemoral access.
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