Transcaval approach for endovascular aortic interventions: A systematic review

Abstract

The caval-aortic path is a novel access route for endovascular aortic interventions in aortic interventions, particularly for patients unsuitable for traditional access routes including femoral, subclavian, transapical, and aortic. A systematic review was conducted as per the PRISMA guidelines utilizing three electronic databases: Medline, Embase, and Cochrane database. There were 10 studies identified, including 7 retrospective studies, 1 prospective cohort study, and 2 case reports. Data on 209 patients (mean age 79.5±5.1 years; 51.2% male) were abstracted including preoperative work-up, technical procedure details, and outcomes. The overall technical success rate for all procedures is 96.2%, with a 4.3% mortality rate and a mean follow up of 17.9±19.8 months. Individually in the various interventions, the technical success rate of transcaval endoleak repair and transcatheter aortic valve implantation (TAVI) was 94.4% and 97.5% respectively, with a low 30-day mortality rate of 7.6% in the TAVI intervention. There is encouraging evidence regarding the rates of mortality and complications in the transcaval approach for endovascular aortic interventions. It presents a feasible alternative for a judiciously select group of patients who are not suitable for other access routes.

Transcaval Access to the Abdominal Aorta: indications of Interest to Surgeons and a Comprehensive Literature Review

“…In addition, references related to this subject but very narrative and repetitive were removed. Finally, 25 reports were selected: three on the access route technique [ 6 - 8 ] , one experimental study [ 9 ] ; three cohort references (one retrospective and two prospective) for TAVI [ 10 - 12 ] ; two cases on TC access for TAVI through a conventional aortic graft [ 13 , 14 ] ; one case on TC access for TAVI through partially thrombosed infrarenal aortic aneurysm [ 15 ] ; one case on TC access for TAVI in a patient with duplicated inferior vena cava [ 16 ] ; one case on TC access for Biventricular Impella placement [ 17 ] ; eight references on six cohorts (retrospective) on the treatment of type II endoleaks after EVAR [ 18 - 25 ] ; two cases on treatment of type I endoleaks after EVAR and after chimney endovascular aneurysm repair (ChEVAR) respectively [ 26 , 27 ] ; two cases on thoracic endovascular aneurysms repair (TEVAR) [ 28 , 29 ] ; and one systematic review on the transcaval access to the aorta [ 30 ] .…”

“…Finally, the systematic review by Wee et al [ 30 ] summarized the current status of this subject: "TC approach for endovascular aortic interventions for patients unsuitable for traditional access routes". The authors described the outcome of 209 patients (TAVI, type II endoleaks and TEVAR) with a mean age of 79.5±5.1 years and 51.2% men.…”

Alternative Access for Transcatheter Aortic Valve Implantation: Current Evidence and Future Directions

“…A recent meta-analysis concluded that the initial evidence is encouraging but further prospective studies are probably required before any firm conclusions can be made. 34 In general, vascular access site complications are a common cause of significant morbidity and mortality after a TAVI procedure. A key role of the heart team should be to identify the access route that will minimise this risk.…”

A case series: alternative access for refractory shock during cardiac arrest

“…In the setting of cardiac arrest, arterial access is crucial for delivery of mechanical circulatory support devices such as an Impella CP ® (Abiomed, Danvers, MA, USA) or cannulation for extracorporeal cardiopulmonary resuscitation (ECMO) 1 , 2 . When the femoral artery is inaccessible due to iliofemoral atherosclerosis, tortuosity, calcifications, abdominal aneurysm, or previous surgery, other approaches should be considered 3 . Transcaval/caval-aortic and percutaneous axillary artery access have both been proven safe alternative access in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis 3–5 …”

“…When the femoral artery is inaccessible due to iliofemoral atherosclerosis, tortuosity, calcifications, abdominal aneurysm, or previous surgery, other approaches should be considered 3 . Transcaval/caval-aortic and percutaneous axillary artery access have both been proven safe alternative access in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis 3–5 …”