Transfemoral aortic valve implantation following lithoplasty of iliac artery in a patient with poor vascular access

Transfemoral approach is considered the preferred route to perform transcatheter aortic valve implantation (TAVI) by most operators due to the low invasiveness and good outcome, as compared to non-transfemoral approach. However, transfemoral access is not always feasible particularly in patients with small and calcific vessels. Recently, catheter-based lithoplasty has emerged as a new technique based on the use of circumferential pulse pressure waves to disrupt calcific plaques. This technology may help to expand eligibility for transfemoral TAVI to patients with calcific ileo-femoral vessels and at high risk for non-transfemoral approach. We present the case of an 87-year-old woman with poor vascular access who successfully underwent transfemoral TAVI following lithoplasty of iliac artery.