ABSTRACT
Introduction In 2002, transcatheter aortic valve implantation (TAVI) was successfully introduced as a new treatment option for aortic valvular stenosis.1 Since then, rapidly rising implantation numbers have proven the feasibility and safety of this promising technology.2-4 When percutaneous aortic valve implantation was in its infancy, it was still necessary to expose the arterial access vessel surgically under general anesthesia. Today, it is usually a truly percutaneous procedure for femoral access with the use of preclosure systems, meaning that the interventions can be carried out under sedation or only local anesthesia. Nevertheless, vascular complications remain a signicant cause of mortality and morbidity with an incidence of 7-15%.5,6 Despite the increasing experience with dierent access-site techniques and preclosure devices, failure to close the percutaneously created arteriotomy remains a dangerous problem with transfemoral TAVI. ese facts require a detailed preprocedural assessment of the access paths, as well as precise management and experience if complications occur. In addition to the transfemoral access site, several other access sites have been proposed. Safety and feasibility of a transsubclavian approach, using a surgical cutdown with subsequent surgical repair aer TAVI, have been demonstrated.7,8 With increasing experience, a truly percutaneous technique for the axillary access was developed-“the Hamburg Sankt Georg Approach.”9
