Accepted Date: 14.02.2014 Available Online Date: 28.04.2014 ©Copyright 2014 by AVES- Available online at www.anakarder.com

Objective: This study aimed to investigate the predictive value of circumferential ilio-femoral calcifications and current, not evidence based manufacturer recommendations in transfemoral (TF) transcatheter aortic valve implantation (TAVI). Methods: A patient cohort with a broad range of ilio-femoral anatomies undergoing TF TAVI (n=132) were retrospectively divided in “suitable” (n=76, 58%) and “unsuitable ” (n=56, 42%) candidates according to current recommendations. Ilio-femoral angiography and reconstructed mul-tislice CT (MSCT) images were used for access screening in the majority of patients. Results: Vessel properties were significantly worse in the “unsuitable group”. The sheath to ilio-femoral artery ratio (SIFAR) and calcium score were 1.35±0.2 and 1.7±0.8 in the unsuitable group. This compared to 1.0±0.12 (p<0.0001) and 1.0±0.7 (p=0.0001) in the “suitable ” patients. Major vascular complications (MVC) occurred more frequently in the “unsuitable ” group (10.7 % vs. 2.6%, p=0.07) and were predicted by SIFAR [OR: 64, CI (95%): 1.4-2971, p=0.03] and circumferential ilio-femoral calcifications [OR: 6, CI (95%): 1.2-26, p=0.025]. In multivariate analysis circumfer-ential calcifications [HR: 3.6, CI: 1-13.2 (CI 95%), p=0.043] but not major vascular complications (MVC) or manufacturer recommendations were associated with increased mortality. Conclusion: According to our results manufacturer recommendations are save but overly conservative. Circumferential ilio-femoral calcifica