Complex femoral accesses

Transcatheter aortic valve implantation (TAVI) has evolved as a minimally invasive technique, and nowadays it represents the first treatment choice for patients with symptomatic severe aortic stenosis both at high surgical risk and in those with moderate perioperative risk. In this chapter, the authors evaluate the most common scenarios that can hamper the success of transfemoral procedures and provide suggestions and recommendations to warrant a safe and effective transcatheter treatment. Ascending aortic dilatation has been reported in up to 25% of patients undergoing TAVI, showing a low risk of intraprocedural adverse aortic events. The combination of severe aortic stenosis and abdominal aortic aneurysms (AAA) is also relatively frequent, with an estimated 6% incidence of AAA in patients undergoing TAVI. Within the aspects to consider during routine vascular assessment prior to TAVI, severe iliofemoral tortuosity plays a key role.