A comparative study on iliofemoral artery calcification distribution in alternative TAVR approaches.

Background: Alternative access approaches are required for transcatheter aortic valve replacement (TAVR) cases wherein the transfemoral approach is restrictive with severe calcification. We aimed to examine the safety of the external iliac artery (EIA) as an alternative access site by evaluating the calcification distributions from the common iliac artery (CIA) to the common femoral arteries (CFA). Methods: We retrospectively enrolled 402 patients who underwent TAVR. Using computed tomography, calcification was visually assessed based on the maximal circumferential involvement, length, and morphology, and its volumes were quantitatively measured using a minimum threshold of 600 Hounsfield units in 804 arteries. Results: The calcification volumes were 0.301 (interquartile range, 0.114-0.624) cc in the CIA, 0.0 (0.0-0.041) cc in the EIA, and 0.047 (0.002-0.158) cc in the CFA ( Conclusions: Calcification rarely presents qualitatively and quantitatively in the EIA, suggesting that it could be an option for TAVR when the transfemoral access is unsuitable. Graphical Abstract: We qualitatively and quantitatively evaluated the distribution of calcification in the iliofemoral arteries of patients who underwent TAVR. The calcification was more rarely present in the EIA than in the CIA or CFA. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-024-01841-3.