The Axillary/Subclavian Artery Access Route for Transcatheter Aortic Valve Replacement: A Systematic Review of the Literature

A primary predictor for success with catheter-based treatment of structural heart disease is having safe remote access to the heart. The devices for transcatheter aortic valve replacement require large-bore access, but many patients with severe aortic stenosis also have iliofemoral disease or relative contraindications to transapical access. In such situations, the leading alternative vascular access site has been the axillary or subclavian artery. This approach has been used with increasing frequency, and as these new devices become more readily available, it is anticipated that the experience will grow. Literature on the use of this access site for transcatheter aortic valve replacement is reviewed to highlight the current understanding about safety of this approach.