JACC Case Rep. 2026 Jun 27:109009. doi: 10.1016/j.jaccas.2026.109009. Online ahead of print.
ABSTRACT
BACKGROUND: The internal endoconduit technique may facilitate transfemoral transcatheter aortic valve replacement (TAVR) in complex vascular anatomies.
CASE SUMMARY: A 71-year-old woman with symptomatic severe aortic stenosis and diffusely narrowed iliac and femoral arteries was considered unsuitable for transfemoral access. A staged, internal endoconduit-assisted transfemoral TAVR was performed. First, overlapping VIABAHN covered stent grafts were deployed to create an arterial conduit in iliofemoral arteries. Two weeks later, a 26-mm Evolut FX valve was successfully implanted. Hemostasis was successfully achieved using Perclose ProStyle sutures and an additional stent graft.
DISCUSSION: The internal endoconduit technique in TAVR has not been previously described in detail. A preprocedural ex vivo simulation was performed to devise an optimal strategy, enabling the safe execution.
TAKE-HOME MESSAGE: The internal endoconduit technique represents a viable alternative for overcoming hostile vascular anatomy during transfemoral TAVR; nonetheless, important considerations remain, such as the interval before TAVR, the graft puncture site, and sheath selection.
PMID:42363929 | DOI:10.1016/j.jaccas.2026.109009