Episode # 48 • 18 Aug 2026
Understanding Transcaval Access for Cardiac Procedures
How can transcaval access transform options for patients with challenging vascular anatomy undergoing TAVR and other cardiac procedures? On this episode of the BackTable Cardiology Podcast, host Dr. Hady Lichaa interviews Dr. Pedro Villablanca, a structural interventionalist at Henry Ford Hospital, about the expanding role of transcaval techniques. They discuss how transcaval access leverages the IVC and aorta to bypass small or diseased vessels, offering transfemoral-like ergonomics, conscious sedation, and less radiation exposure for carefully selected patients.
Timestamps
00:00 - Introduction
02:35 - What Is Transcaval Access?
09:34 - Crossing Site Measurements
17:17 - Step-by-Step Procedure
20:26 - Electrosurgery Setup
28:04 - Troubleshooting Scenarios
34:36 - Lost Wire Recovery
39:19 - Balloon Tamponade Planning
44:00 - Step-by-Step Closure
53:31 - Hydration and Hemoglobin
01:00:42 - Training and Proctorship
01:04:42 - Conclusion
Resources
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More about this episode
The conversation offers a step-by-step walkthrough of transcaval TAVR, covering pre-procedural planning with CT and fluoroscopy, device selection, and troubleshooting for complications like lost wires and bleeding. Dr. Villablanca details closure strategies, balloon tamponade, and the use of cover stents as bailouts. They discuss the importance of multidisciplinary planning, anatomic considerations, and practical pearls from real cases. The episode closes with advice for operators new to transcaval access and emphasizes the value of preparation, collaboration, and continuous learning in mastering this advanced technique.
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