Modified transiliac artery approach for transcatheter aortic valve implantation.

We present a safe and effective method of transcatheter aortic valve implantation using an artificial graft anastomosed to the common iliac artery. A 10-mm woven polyethylene terephthalate graft is anastomosed to the common iliac artery. A guide wire and an expandable sheath are inserted through the graft, and bleeding from the puncture site is controlled by three tourniquets circled around the graft. Using this technique, we can bring the graft outside of the retroperitoneal space, allowing easy manipulation of the guide-wire and sheath, unimpeded by the constraints of the deep and narrow retroperitoneal space.