"Double-Stick" Transsubclavian Transcatheter Aortic Valve Replacement With Use of a Balloon Expandable Valve: A Less Invasive Option for Alternative Access.

Access options for transcatheter aortic valve replacement (TAVR) currently include transfemoral, transaortic, transapical, transsubclavian, and other approaches. Transsubclavian access for balloon expandable valves is gaining popularity when transfemoral access is not suitable, given its peripheral access compared with central access. With the transsubclavian approach, second femoral or radial artery access is necessary for pigtail catheter placement. We describe a "double-stick" transsubclavian technique that eliminates secondary arterial access. With this technique, the transsubclavian approach can still be used in patients with advanced femoral disease, and it allows for rapid ambulation in most patients.