Percutaneous management of vascular access in transfemoral transcatheter aortic valve implantation

Table 3 Materials for bailout endovascular interventions to manage vascular access complications (through contralateral femoral access using the “crossover” technique)

Complication	Type of bailout endovascular intervention	Devices needed
Any type	Immediate angiography and prompt access to the affected iliac-femoral axis1	6-9 F long (45 cm) sheaths
Iliac-femoral arteries rupture/ perforation	Immediate hemostasis to avoid shock	Large peripheral balloons in iliac arteries (diameter: 7-10 mm) or elastomeric balloon in the distal aorta
	Vascular sealing in case of persistent blood extravasation after prolonged balloon inflation	Covered stent (diameter: 7-10 mm)
Failure of hemostasis at the entry site	Prolonged balloon inflation proximal to the entry site during external manual compression	Mid-sized peripheral balloons (diameter: 6-8 mm)
Iliac-femoral arteries flow-limiting dissection	Immediate restoration of antegrade flow to avoid acute limb ischemia	Large peripheral balloons (diameter: 7-10 mm)
	Vascular sealing in case of significant stenosis/dissection after balloon inflation	Peripheral self-expandable nitinol stents (diameter: 7-10 mm)
Iliac-femoral arteries acute thrombotic occlusion	Immediate restoration of antegrade flow to avoid acute limb ischemia	Thrombus aspiration with thrombus-extraction devices (angiojet, thrombus-aspirating catheters) or with coronary guiding catheters (multipurpose curve) Peripheral balloons (diameter: 5-10 mm) Consider distal filter protection to avoid embolization and avoid aggressive dilations since dethrombosis is usually facilitated by antegrade flow restoration

¹Provisional delivery of a sentinel wire (i.e., a 0.014”-0.018” wire placed in cross-over in distal femoral artery and jailed under the 18 F sheath) allows continuous control of the entry site and quick access to contralateral iliac-femoral axis if needed.