Axillary conduit creation and passive femoral to carotid cerebral perfusion shunt creation for challenging transcatheter aortic valve placement

Alternate access solutions are needed in patients where standard transfemoral delivery of transcatheter aortic valve replacement (TAVR) devices is deemed prohibitive.We present a case of a 78-year-old male patient with a past medical history significant for severe aortic arch disease, peripheral artery disease, and symptomatic aortic stenosis requiring an alternative access solution for TAVR.The combination of an axillary conduit with a TCAR arterial and venous sheath was utilized to create an access point for the TAVR device and an avenue for cerebral embolic protection with passive cerebral perfusion.