TransCaval Approach TAVI

 

7F JR4 Guidecatheter 100cm

7F IM 55cm or JR4 55cm

Astato 20g 300cm angioplasty wire

Piggyback wire convertor (Vascular Solutions) or Navicross microcatheter 90cm (Terumo)

6F Finecross 130cm

Gooseneck snare (EV3) 25mm

Hemostasis valve for the Snare system

Lunderquist extra stiff wire

Diathermy pen and machine (Bovie system)

 

Closure:

BMW 300cm angioplasty wire (as buddy wire)

Amplatzer duct occluder 10/8 or 8/6 (1st generation)

6F Torqvue 180deg/80cm Delivery System (for duct occluder)

Agilis NxT small curl 8.5F 61cm

 

Bail out kits:

PTS-X 25mm sizing balloon (for balloon tamponade)

8F femoral sheath upgrade for sizing balloon

Endologix endografts and delivery system or 

Trivascular ovation ix iliac limb extensions

 

Usual TAVI equipment

4F, 6F, 7F, 8F, 10F femoral sheaths

 

PROCEDURE Access:

ARTERIAL -> 6F

VENOUS -> 4F then upsize to 10F

 

Crossing System:

Astato 20g 300cm angioplasty wire (straight tip), inside a...

Piggyback wire convertor or 130cm Finecross, inside a...

Navicross braided 0.035 microcatheter, to deliver later...

Lunderquist wire

 

Attach the denuded end of Astato wire to diathermy pen with 50 pure CUT ONLY

 

Venous:

7F JR4 or IM 55cm guidecath to femoral vein

Arterial:

6F JR4 100cm guidecath with Gooseneck 25mm snare

 

Steps:

Simutaneously (with someone pressing the diathermy pen) advance the astato wire towards aorta side, then catch the wire with the snare in the aorta side then advance the whole system upwards.

Remove the astato wire and finecross and replace with Lunderquist wire

Then the usual TAVI routine.

 

Closure of Hole:

Amplatzer duct occluder system in the Agilis small curl system to position the 8/6mm plug, with Pigtail catheter in the arterial side to visualize position using Biplane views.