Transcaval Access to the Abdominal Aorta: indications of Interest to Surgeons and a Comprehensive Literature Review

Sánchez, Francisco S. Lozano; González, Ignacio Cruz; Calvo, Roberto Salvador; Fernández, Pedro Luis Sánchez

doi:10.21470/1678-9741-2019-0240

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Brasil

Brazilian Journal of Cardiovascular Surgery

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Brasil

Español English

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Sumário

REVIEW ARTICLE • Braz. J. Cardiovasc. Surg. 35 (5) • Sep-Oct 2020 • https://doi.org/10.21470/1678-9741-2019-0240 copy

Transcaval Access to the Abdominal Aorta: indications of Interest to Surgeons and a Comprehensive Literature Review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

We performed a review of the literature (until August 01, 2019) on the occasion of the first transcaval approach for transcatheter aortic valve implantation in our hospital. This review focuses mainly on the indications of this alternative access route to the aorta. It may be useful for vascular surgeons in selected cases, such as the treatment of endoleaks after endovascular aneurysm repair and thoracic endovascular aneurysm repair. We describe historical aspects of transcaval access to the aorta, experimental studies, available case series and outcomes. Finally, we summarize the most significant technical aspects of this little-known access.

Keywords:
Endoleak. Transcatheter Aortic Valve Replacement. Aortic Aneurysm. Abdominal. Blood Vessel Prosthesis Implantation. Endovascular Procedures. Aorta; Surgeons

Abbreviations, acronyms & symbols
ChEVAR EVAR TAVI TAVR TC TEVAR	= Chimney endovascular aneurysm repair = Endovascular aneurysm repair = Transcatheter aortic valve implantation = Transcatheter aortic valve replacement = Transcaval = Thoracic endovascular aneurysms repair

Author/s [reference]	Journal, year (authors' country)	No. of cases	Technical success (%)	Follow-up (months)
TAVI
- Greenbaum et al.^[¹⁰10 Greenbaum AB, O'Neill WW, Paone G, Guerrero ME, Wyman JF, Cooper RL, et al. Caval-aortic access to allow transcatheter aortic valve replacement in otherwise ineligible patients: initial human experience. J Am Coll Cardiol. 2014;63(25 Pt A):2795-804. doi: 10.1016/j.jacc.2014.04.015. https://doi.org/10.1016/j.jacc.2014.04.0... ^]	J Am Coll Cardiol, 2014 (US)	19	89.5	111±57
- Greenbaum et al.^[¹¹11 Greenbaum AB, Babaliaros VC, Chen MY, Stine AM, Rogers T, O'Neill WW, Paone G, Thourani VH, Muhammad KI, Leonardi RA, Ramee S, Troendle JF, Lederman RJ. Transcaval Access and Closure for Transcatheter Aortic Valve Replacement: A Prospective Investigation. J Am Coll Cardiol. 2017;69(5):511-521. doi: 10.1016/j.jacc.2016.10.024. https://doi.org/10.1016/j.jacc.2016.10.0... ^]	J Am Coll Cardiol, 2017 (US)	100	99	1
- Lederman et al.^[¹²12 Lederman RJ, Babaliaros VC, Rogers T, Stine AM, Chen MY, Muhammad KI, et al. The Fate of Transcaval Access Tracts: 12-Month Results of the Prospective NHLBI Transcaval Transcatheter Aortic Valve Replacement Study. JACC Cardiovasc Interv. 2019;12(5):448-456. doi: 10.1016/j.jcin.2018.11.035. https://doi.org/10.1016/j.jcin.2018.11.0... ^]	J Am Coll Cardiol Interv, 2019 (US)	100	100	12
TAVI ^* TAVI=transcatheter aortic valve implantation; TEVAR=thoracic endovascular aneurysm repair.
- Lederman et al.^[¹³13 Lederman RJ, O'Neill WW, Greenbaum AB. Transcaval access for TAVR across a polyester aortic graft. Catheter Cardiovasc Interv. 2015;85(7):1270-3. doi: 10.1002/ccd.25781. https://doi.org/10.1002/ccd.25781... ^]	Catheter Cardiovasc Interv, 2015 (US)	1	100	1
- Lanz et al.^[¹⁴14 Lanz J, Pilgrim T, Greenbaum AB, Lederman RJ, Windecker S. Sheathless Transcaval Transcatheter Aortic Valve Implantation Through an Abdominal Aortic Graft. Can J Cardiol. 2018;34(12):1688.e17-1688.e19. doi: 10.1016/j.cjca.2018.10.003. https://doi.org/10.1016/j.cjca.2018.10.0... ^]	Can J Cardiol, 2018 (Switzerland)	1	100	6
- Piayda et al.^[¹⁵15 Piayda K, Veulemans V, Kelm M, Zeus T. Transcaval aortic valve implantation through a partially thrombosed infrarenal aortic aneurysm. Eur Heart J. 2020;41(8):974. doi: 10.1093/eurheartj/ehz164. https://doi.org/10.1093/eurheartj/ehz164... ^]	Eur Heart J, 2019 (Germany)	1	100	1
- Fanari et al.^[¹⁶16 Fanari Z, Al-Akchar M, Mahmaljy H, Goel S, Goswami NJ. Transcatheter aortic valve replacement through transcaval aortic access in a patient with duplicated inferior vena cava and poor iliofemoral anatomy. Cardiovasc Revasc Med. 2017;18(8):604-606. doi: 10.1016/j.carrev.2017.06.011. https://doi.org/10.1016/j.carrev.2017.06... ^]	Cardiovasc Revasc Med, 2017 (US)	1	100	1
Biventricular Impella
- Kamioka et al.^[¹⁷17 Kamioka N, Patel A, Burke MA, Greenbaum A, Babaliaros V. Biventricular Impella placement via complete venous access. Catheter Cardiovasc Interv. 2019;93(6):E343-E345. doi: 10.1002/ccd.27103. https://doi.org/10.1002/ccd.27103... ^]	Catheter Cardiovasc Interv, 2019 (US)	1	100	5
Type II endoleaks
- Stavropoulos et al.^[¹⁸18 Stavropoulos SW, Carpenter JP, Fairman RM, Golden MA, Baum RA. Inferior vena cava traversal for translumbar endoleak embolization after endovascular abdominal aortic aneurysm repair. J Vasc Interv Radiol. 2003;14(9 Pt 1):1191-4. doi: 10.1097/01.rvi.0000085771.71254.14. https://doi.org/10.1097/01.rvi.000008577... ^]	J Vasc Interv Radiol, 2003 (US)	9	100	12
- Mansueto et al.^[¹⁹19 Mansueto G, Cenzi D, D'Onofrio M, Petrella E, Gumbs AA, Mucelli RP. Treatment of type II endoleaks after endovascular repair of abdominal aortic aneurysms: transcaval approach. Cardiovasc Intervent Radiol. 2005;28(5):641-5. doi: 10.1007/s00270-004-0328-6. https://doi.org/10.1007/s00270-004-0328-... ^]	Cardiovasc Intervent Radiol, 2005 (Italy)	3	100	1
- Mansueto et al.^[²⁰20 Mansueto G, Cenzi D, Scuro A, Gottin L, Griso A, Gumbs AA, Mucelli RP. Treatment of type II endoleak with a transcatheter transcaval approach: results at 1-year follow-up. J Vasc Surg. 2007;45(6):1120-7.^]	J Vasc Surg, 2007 (Italy)	12	92	6
- Scali et al.^[²¹21 Scali ST, Vlada A, Chang CK, Beck AW. Transcaval embolization as an alternative technique for the treatment of type II endoleak after endovascular aortic aneurysm repair. J Vasc Surg 2013;57(3):869-74.^]	J Vasc Surg, 2013 (US)	6	100	10.0±5.8
- Gandini et al.^[²²22 Gandini R, Chiocchi M, Loreni G, Del Giudice C, Morosetti D, Chiaravalloti A, et al. Treatment of type II endoleak after endovascular aneurysm repair: the role of selective vs. nonselective transcaval embolization. J Endovasc Ther. 2014;21(5):714-22. doi: 10.1583/14-4571MR.1. https://doi.org/10.1583/14-4571MR.1... ^]	J Endovasc Ther, 2014 (Italy)	26	100	24.0±6.4
- Giles et al.^[²³23 Giles KA, Fillinger MF, De Martino RR, Hoel AW, Powell RJ, Walsh DB. Results of transcaval embolization for sac expansion from type II endoleaks after endovascular aneurysm repair. J Vasc Surg. 2015;61(5):1129-36. doi: 10.1016/j.jvs.2014.12.002. https://doi.org/10.1016/j.jvs.2014.12.00... ^]	J Vasc Surg, 2015 (US)	29	89.7	16.5±10.4
- Burley et al.^[²⁴24 Burley CG, Kumar MH, Bhatti WA, Boyd C, Sales CM. Transcaval embolization as the preferred approach. J Vasc Surg. 2019;69(4):1309-13. doi: 10.1016/j.jvs.2018.08.177. https://doi.org/10.1016/j.jvs.2018.08.17... ^]	J Vasc Surg, 2019 (US)	10	90	6
- Hyatt et al.^[²⁵25 Hyatt E, McLaughlin JN, Shah H, Kalva SP. Transcaval approach for embolization of type II Endoleak following endovascular aortic aneurysm repair. CVIR Endovasc. 2019;2(1):3. doi: 10.1186/s42155-018-0047-8. https://doi.org/10.1186/s42155-018-0047-... ^]	CVIR Endovasc, 2019 (US)	1	100	1
Type I endoleaks
- Gandini et al.^[²⁶26 Gandini R, Del Giudice C, Abrignani S, Vasili E, Pampana E, Simonetti G. Inexplicable late type Ia endoleak associated with the low-profile Ovation endograft in a patient with favorable neck anatomy: treatment with transcaval coil embolization. J Endovasc Ther. 2015;22(3):426-30. doi: 10.1177/1526602815579898. https://doi.org/10.1177/1526602815579898... ^]	J Endovasc Ther, 2015 (Italy)	1	100	12
- Massimi et al.^[²⁷27 Massimi TM, Kostun ZW, Woo EY. Transcaval embolization of a type I gutter endoleak after three-vessel chimney endovascular aneurysm repair. J Vasc Surg. 2017;65(5):1515-7. doi: 10.1016/j.jvs.2016.09.043. https://doi.org/10.1016/j.jvs.2016.09.04... ^]	J Vasc Surg, 2017 (US)	1	100	1
TEVAR
- Uflacker et al.^[²⁸28 Uflacker A, Lim S, Ragosta M, Haskal ZJ, Lederman RJ, Kern J, et al. Transcaval Aortic Access for Percutaneous Thoracic Aortic Aneurysm Repair: Initial Human Experience. J Vasc Interv Radiol. 2015 Oct;26(10):1437-41. doi: 10.1016/j.jvir.2015.07.024. https://doi.org/10.1016/j.jvir.2015.07.0... ^]	J Vasc Interv Radiol, 2015 (US)	1	100	1
- Fanari et al.^[²⁹29 Fanari Z, Hammami S, Goswami NJ, Goldstein JA. Percutaneous thoracic aortic aneurysm repair through transcaval aortic access. Catheter Cardiovasc Interv. 2017;90(5):806-808. doi: 10.1002/ccd.27130. https://doi.org/10.1002/ccd.27130... ^]	Catheter Cardiovasc Interv, 2017 (US)	1	100	1

Author/s [reference]	No.	Age	Men	Vein access	Embolization technique	Mortality (30 days)	Complications (30 days)	Recurrence
Stavropoulos et al.^[¹⁸18 Stavropoulos SW, Carpenter JP, Fairman RM, Golden MA, Baum RA. Inferior vena cava traversal for translumbar endoleak embolization after endovascular abdominal aortic aneurysm repair. J Vasc Interv Radiol. 2003;14(9 Pt 1):1191-4. doi: 10.1097/01.rvi.0000085771.71254.14. https://doi.org/10.1097/01.rvi.000008577... ^]	9	-	-	-	-	-	-	-
Mansueto et al.^[¹⁹19 Mansueto G, Cenzi D, D'Onofrio M, Petrella E, Gumbs AA, Mucelli RP. Treatment of type II endoleaks after endovascular repair of abdominal aortic aneurysms: transcaval approach. Cardiovasc Intervent Radiol. 2005;28(5):641-5. doi: 10.1007/s00270-004-0328-6. https://doi.org/10.1007/s00270-004-0328-... ^,²⁰20 Mansueto G, Cenzi D, Scuro A, Gottin L, Griso A, Gumbs AA, Mucelli RP. Treatment of type II endoleak with a transcatheter transcaval approach: results at 1-year follow-up. J Vasc Surg. 2007;45(6):1120-7.^]	12	79.0±5.3	92%	F(42%)/J (58%)	Standard	0	8%	8.3%
Scali et al.^[²¹21 Scali ST, Vlada A, Chang CK, Beck AW. Transcaval embolization as an alternative technique for the treatment of type II endoleak after endovascular aortic aneurysm repair. J Vasc Surg 2013;57(3):869-74.^]	6	72.7±10.8	100%	Femoral	Standard	0	0%	34%
Gandini et al.^[²²22 Gandini R, Chiocchi M, Loreni G, Del Giudice C, Morosetti D, Chiaravalloti A, et al. Treatment of type II endoleak after endovascular aneurysm repair: the role of selective vs. nonselective transcaval embolization. J Endovasc Ther. 2014;21(5):714-22. doi: 10.1583/14-4571MR.1. https://doi.org/10.1583/14-4571MR.1... ^]	26	75±5.6	-	Femoral	Standard	0	7.7%	15.4%
Giles et al.^[²³23 Giles KA, Fillinger MF, De Martino RR, Hoel AW, Powell RJ, Walsh DB. Results of transcaval embolization for sac expansion from type II endoleaks after endovascular aneurysm repair. J Vasc Surg. 2015;61(5):1129-36. doi: 10.1016/j.jvs.2014.12.002. https://doi.org/10.1016/j.jvs.2014.12.00... ^]	29	78±7.1	83%	Femoral	Standard	0	0%	17%
Burley et al.^[²⁴24 Burley CG, Kumar MH, Bhatti WA, Boyd C, Sales CM. Transcaval embolization as the preferred approach. J Vasc Surg. 2019;69(4):1309-13. doi: 10.1016/j.jvs.2018.08.177. https://doi.org/10.1016/j.jvs.2018.08.17... ^].	10	82.0±7	80%	Femoral	Standard	0	0%	10%
Hyatt et al.^[²⁵25 Hyatt E, McLaughlin JN, Shah H, Kalva SP. Transcaval approach for embolization of type II Endoleak following endovascular aortic aneurysm repair. CVIR Endovasc. 2019;2(1):3. doi: 10.1186/s42155-018-0047-8. https://doi.org/10.1186/s42155-018-0047-... ^]	1	75	100%	Femoral	Standard	0	0%	-

Author/s [reference]	No.	Age/sex	Repair indication	Previous surgery	Endograft	Material of embolization
Gandini et al.^[²⁶26 Gandini R, Del Giudice C, Abrignani S, Vasili E, Pampana E, Simonetti G. Inexplicable late type Ia endoleak associated with the low-profile Ovation endograft in a patient with favorable neck anatomy: treatment with transcaval coil embolization. J Endovasc Ther. 2015;22(3):426-30. doi: 10.1177/1526602815579898. https://doi.org/10.1177/1526602815579898... ^]	1	82/man	Type IA endoleak	EVAR (7 months)	Ovation	Coils and thrombin
Massimi et al.^[²⁷27 Massimi TM, Kostun ZW, Woo EY. Transcaval embolization of a type I gutter endoleak after three-vessel chimney endovascular aneurysm repair. J Vasc Surg. 2017;65(5):1515-7. doi: 10.1016/j.jvs.2016.09.043. https://doi.org/10.1016/j.jvs.2016.09.04... ^]	1	77/man	Gutter-related type I endoleak	ChEVAR^* * Superior mesenteric artery and two renal arteries. (1 month)	Not reported	Coils

Author/s [reference]	No.	Age/sex	Repair indication	Open surgery rejected	Indication TC	Endograft	Fistula closure
Uflacker et al.^[²⁸28 Uflacker A, Lim S, Ragosta M, Haskal ZJ, Lederman RJ, Kern J, et al. Transcaval Aortic Access for Percutaneous Thoracic Aortic Aneurysm Repair: Initial Human Experience. J Vasc Interv Radiol. 2015 Oct;26(10):1437-41. doi: 10.1016/j.jvir.2015.07.024. https://doi.org/10.1016/j.jvir.2015.07.0... ^]	1	61/man	TAA 4.5-5.9 cm	High comorbidity	Iliac arteries <6 mm	Valiant (Medtronic^®)	Amplatzer (St. Jude^®)
Fanari et al.^[²⁹29 Fanari Z, Hammami S, Goswami NJ, Goldstein JA. Percutaneous thoracic aortic aneurysm repair through transcaval aortic access. Catheter Cardiovasc Interv. 2017;90(5):806-808. doi: 10.1002/ccd.27130. https://doi.org/10.1002/ccd.27130... ^]	1	65/man	TAA 5.3-6.3 cm	High comorbidity	Unsuitable iliac access	Valiant (Medtronic^®)	Amplatzer (St. Jude^®)

Authors' roles & responsibilities

FSLS
ICG
RSC
PLSF

Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; final approval of the version to be published
Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; final approval of the version to be published
Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; final approval of the version to be published
Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; final approval of the version to be published

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[1] Francisco S. Lozano Sánchez, Department of Angiology and Vascular Surgery, Salamanca University Hospital Paseo de San Vicente, s/n, Salamanca, Spain Zip code: 37007 E-mail: lozano@usal.es