{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T11:07:14Z","timestamp":1789384034047,"version":"build-2803163510"},"reference-count":47,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy Carol Davila"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Hostile abdominal aortic anatomy may limit transfemoral transcatheter aortic valve implantation (TAVI), even when the iliofemoral access vessels are suitable. The principal anatomical substrate is advanced atherosclerotic calcification, which may cause luminal stenosis, reduced arterial compliance, and an increased risk of vascular injury or embolization during large-bore device passage. Evidence regarding endovascular access facilitation is derived predominantly from iliofemoral interventions, whereas experience with direct modification of the abdominal aorta remains limited. This review examines balloon angioplasty, intravascular lithotripsy, and other endovascular strategies used to facilitate transfemoral TAVI in hostile iliofemoral and aortic anatomy, complemented by an illustrative case highlighting the additional challenge posed by intraluminal foreign material. Within this context, we present a 75-year-old high-risk patient with symptomatic severe aortic stenosis and significant coronary artery disease, in whom otherwise suitable iliofemoral access was complicated by focal calcific abdominal aortic stenosis and an asymptomatic impacted fragment of a fractured superior mesenteric artery stent following a previous intervention. A staged strategy comprising coronary revascularization, abdominal aortic balloon angioplasty with apposition of the fragment against the aortic wall, and subsequent balloon-expandable TAVI was successfully performed. This case underscores the importance of individualized, imaging-guided planning for complex transfemoral access.<\/jats:p>","DOI":"10.3390\/life16091527","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T10:19:41Z","timestamp":1789381181000},"page":"1527","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Enabling Transfemoral TAVI Through a Hostile Abdominal Aortic Anatomy and a Migrated Mesenteric Stent Fragment: Review of the Literature and a Case Presentation"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9129-4363","authenticated-orcid":false,"given":"Catalina-Andreea","family":"Parasca","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Cardiovascular Surgery, \u201cProf. Dr. C.C. Iliescu\u201d Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9524-4029","authenticated-orcid":false,"given":"Crina-Ioana","family":"Radulescu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, \u201cProf. Dr. C.C. Iliescu\u201d Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pavel","family":"Platon","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology, \u201cProf. Dr. C.C. Iliescu\u201d Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1103-8437","authenticated-orcid":false,"given":"Andreea","family":"Calin","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Cardiology, \u201cProf. Dr. C.C. Iliescu\u201d Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serban","family":"Bubenek-Turconi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Anesthesiology and Intensive Care, \u201cProf. Dr. C.C. Iliescu\u201d Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan A.","family":"Popescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Cardiology, \u201cProf. Dr. C.C. Iliescu\u201d Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9069-2722","authenticated-orcid":false,"given":"Vlad Anton","family":"Iliescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Cardiovascular Surgery, \u201cProf. Dr. C.C. Iliescu\u201d Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2492","DOI":"10.1016\/j.jacc.2020.09.595","article-title":"STS-ACC TVT Registry of Transcatheter Aortic Valve Replacement","volume":"76","author":"Carroll","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Sawaya, F.J., Bajoras, V., Vanhaverbeke, M., Wang, C., Bieliauskas, G., S\u00f8ndergaard, L., and De Backer, O. (2021). Intravascular Lithotripsy-Assisted Transfemoral TAVI: The Copenhagen Experience and Literature Review. Front. Cardiovasc. 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Heart J."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/9\/1527\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T10:41:14Z","timestamp":1789382474000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/9\/1527"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,14]]},"references-count":47,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["life16091527"],"URL":"https:\/\/doi.org\/10.3390\/life16091527","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,14]]}}}