Transcatheter aortic valve replacement: Alternative access beyond the femoral arterial approach

Aortic stenosis is the most prevalent valvular cardiovascular disease affecting the population over the age of 65 years. Transcatheter aortic valve replacement (TAVR) was developed as a minimally invasive surgical intervention to treat aortic stenosis in patients at high risk for surgical complications. Although the most commonly used approach for placement of a transcatheter aortic valve is in retrograde fashion via a transfemoral approach, narrowed luminal diameters, extensive atherosclerotic disease, or significant tortuosity may limit use of this route. In these patients, alternative methods including subclavian, transaortic, and transapical approaches should be considered. An understanding of these access routes and their respective indications and contraindications allows the radiologist to provide additional preprocedure measurements and images to help guide placement of the valve.