Portico Sheathless Transcatheter Aortic Valve Implantation via Distal Axillary Artery Giuseppe Bruschi, MD, Paola Colombo, MD, PhD, Luca Botta, MD, PhD,

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Portico Sheathless Transcatheter Aortic Valve Implantation via Distal Axillary Artery Giuseppe Bruschi, MD, Paola Colombo, MD, PhD, Luca Botta, MD, PhD, Stefano Nava, MD, Bruno Merlanti, MD, Oriana Belli, MD, Francesco Musca, MD, Francesco Soriano, MD, Claudio F. Russo, MD, Fabrizio Oliva, MD The Annals of Thoracic Surgery Volume 103, Issue 2, Pages e175-e177 (February 2017) DOI: 10.1016/j.athoracsur.2016.07.065 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Three-dimensional multislice computed tomography evidence of femoral-iliac severe tortuosity. (B) The Portico delivery system was advanced sheathless over the super-stiff wire from distal axillary artery access. (C) Portico bioprosthesis was deployed under fluoroscopic and angiographic guidance. Final aortography revealed normal valve function and coronary flow without any paravalvular regurgitation. (D) Predischarge axillary artery wound. The Annals of Thoracic Surgery 2017 103, e175-e177DOI: (10.1016/j.athoracsur.2016.07.065) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 The left subclavian artery arises from the arch of the aorta, and the artery lies behind the scalenus and forms the highest part of the arch described by the vessel. The distal portion of the subclavian artery runs downward to the outer border of the first rib, where it becomes the axillary artery. The first portion of the axillary artery is covered by the clavicular portion of the Pectoralis major. The second portion of the axillary artery is covered by the pectorales major and minor. The third portion of the axillary artery extends from the lower border of the pectoralis minor to the lower border of the tendon of the teres major. The Annals of Thoracic Surgery 2017 103, e175-e177DOI: (10.1016/j.athoracsur.2016.07.065) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions