Abstract
Over the past decade there have been huge advances in transfemoral (TF) transcatheter aortic valve implantation (TAVI), including changes to both the prosthesis and delivery systems. This evolution has resulted in lower profile delivery systems thus enabling TF TAVI to be performed completely percutaneously. Whereas previously access was achieved predominantly via the femoral artery using a surgical cutdown technique, the use of a vascular closure device (VCD) has now become standard practice. Percutaneous TF TAVI has been proven to be safer with improved efficacy over alternative access routes. Benefits include early mobilization within 24 hours of the procedure and shorter length of hospital stay. However, vascular closure is not completely without risk and the vast majority of TAVI-related complications are vascular, attributable to unsuccessful vascular closure. This chapter reviews the advantages of fully percutaneous access and the different commercially available percutaneous closure devices used in TF TAVI and a stepwise approach to closure device delivery.
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