Step-by-step Guide to Transcaval Access: With and without CT Planning

Abstract

Transcaval access was first described in animals in 2013 and in humans in 2014. It was initially developed for patients with peripheral artery disease who were undergoing transcatheter aortic valve replacement (TAVR), a procedure that requires large-bore access. Since then, transcaval access has been increasingly adopted worldwide and has emerged as a safe and viable alternative to conventional femoral access for TAVR. With more evidence supporting the safety of transcaval access and an increasing number of procedures requiring large-bore arterial access, the application of transcaval access has been expanded for mechanical circulatory support devices and aortic procedures. Transcaval access has also been adopted by the 2024 Society for Cardiovascular Angiography and Interventions expert consensus statement as a superior alternative over transaxillary access for TAVR. This article aims to provide a step-by-step guide for transcaval access (with and without CT planning), emphasising preoperative planning, transcaval crossing and closure and troubleshooting.