Author + information
- Received February 3, 2013
- Accepted February 15, 2013
- Published online August 1, 2013.
- Chiara Bernelli, MD,
- Francesco Maisano, MD,
- Alaide Chieffo, MD,
- Matteo Montorfano, MD,
- Jaclyn Chan, MBBS,
- Davide Maccagni, RT and
- Antonio Colombo, MD∗ ()
- ↵∗Reprint requests and correspondence:
Dr. Antonio Colombo, Interventional Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina 60 20132 Milan, Italy.
Endovascular stent-graft implantation can be used to manage access site vascular complications during transcatheter aortic valve implantation (1). Nonetheless, the deployment of these devices may be technically challenging.
An 85-year-old man underwent a transfemoral transcatheter aortic valve implantation using a 29-mm CoreValve ReValving System (Medtronic Inc., Minneapolis, Minnesota). Following failure of therapeutic access pre-closure by Prostar XL (Abbott Vascular Devices, Redwood City, California) a Viabahn Endoprosthesis (W. L. Gore & Associates, Flagstaff, Arizona) was deployed. However, because the previous contralateral wire was inadvertently positioned in the profunda, the Viabahn occluded the superficial femoral artery (Fig. 1A). Therefore, in order to reaccess the superficial femoral artery, a Brockenbrough needle and Mullins sheath (Medtronic, Minneapolis, Minnesota) were used to perforate the covered stent (Figs. 1B and 1C). After puncture, a 0.014-inch wire was advanced in the superficial femoral artery and dilation of the covered stent with a 5.5-×-20-mm balloon was performed (Fig. 1D). Branch patency was restored with TIMI (Thrombolysis In Myocardial Infarction) flow grade 3 and a “neo-femoral carina” was created (Fig. 1E).
The “neocarina reconstruction-technique” may be applied to manage vascular complications in various interventional procedures. However, the clinical impact of this new technique on the long-term patency of the stent graft and the need for close surveillance remain unclear.
Dr. Maisano he has received consulting fees from Medtronic, Abbott, St. Jude Medical, and Valtech Cardio; royalties from Edwards Lifesciences; and is a cofounder of 4tech. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 3, 2013.
- Accepted February 15, 2013.
- American College of Cardiology Foundation