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Anatomic Suitability for Transcaval Access Based on Computed Tomography.
- Source :
-
JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2017 Jan 09; Vol. 10 (1), pp. 1-10. - Publication Year :
- 2017
-
Abstract
- Transcaval access has been used successfully for over 200 transcatheter aortic valve replacements, large-bore percutaneous left ventricular assist devices, and thoracic endovascular aortic aneurysm repairs. This review teaches how to plan transcaval access and closure based on computed tomography. The main planning goals are to: 1) identify calcium-free crossing targets in the abdominal aorta along with optimal fluoroscopic projection angles and level with respect to lumbar vertebrae; 2) identify obstacles such as interposed bowel or pedunculated aortic atheroma; 3) plan covered stent bailout; and 4) identify jeopardized vascular branches such as renal arteries that might be obstructed by bailout covered stents if employed. The aorta and inferior vena cava are segmented (sculpted) using an image reconstruction workstation and crossing targets are highlighted. Important measurements such as aortic lumen diameter and target distance from renal arteries, aortoiliac bifurcation, and right femoral vein puncture site are reported to assist the operator. The proposed classification for transcaval feasibility has been revised, making some previously unfavorable candidates now feasible or favorable based on procedural success to date. Transcaval access allows percutaneous introduction of large devices into the aorta despite small or diseased iliofemoral arteries. By following these simplified procedures, both operators and imaging specialists can easily prepare comprehensive treatment plans.<br /> (Copyright © 2017 American College of Cardiology Foundation. All rights reserved.)
- Subjects :
- Anatomic Landmarks
Aortic Aneurysm diagnostic imaging
Aortic Aneurysm surgery
Endovascular Procedures instrumentation
Endovascular Procedures methods
Heart-Assist Devices
Humans
Predictive Value of Tests
Prosthesis Implantation instrumentation
Prosthesis Implantation methods
Renal Artery diagnostic imaging
Stents
Transcatheter Aortic Valve Replacement methods
Vascular Calcification diagnostic imaging
Aorta, Abdominal diagnostic imaging
Aortography methods
Computed Tomography Angiography
Patient Selection
Phlebography methods
Vena Cava, Inferior diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7605
- Volume :
- 10
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 28057275
- Full Text :
- https://doi.org/10.1016/j.jcin.2016.09.002