RT Journal Article SR Electronic T1 Transcatheter aortic valve replacement using the iSleeve expandable sheath in small femoral arteries JF Open Heart JO Open Heart FD British Cardiovascular Society SP e001703 DO 10.1136/openhrt-2021-001703 VO 8 IS 2 A1 Natalie Glaser A1 Crochan J. O'Sullivan A1 Nawzad Saleh A1 Dinos Verouhis A1 Magnus Settergren A1 Rickard Linder A1 Andreas Rück YR 2021 UL http://openheart.bmj.com/content/8/2/e001703.abstract AB Background Small femoral arteries have been associated with a higher risk of vascular complications in transfemoral transcatheter aortic valve replacement (TAVR). We investigated the feasibility and safety of TAVR in patients with small femoral arteries.Methods In this observational study, we included 82 patients who underwent transfemoral TAVR with the ACURATE neo system using the expandable 14F iSleeve sheath between 2018 and 2019 at Karolinska University Hospital, Sweden. Of these, 41 patients had a minimal femoral artery diameter of ≥5.5 mm (mean 6.5, range 5.5–9.2), and 41 patients had a minimal femoral artery diameter <5.5 mm (mean 4.9, range 3.9–5.4).Results There was no significant difference in major vascular and bleeding complications between the small femoral artery group (7%) and the normal femoral artery group (2%) (p=0.62). The total of major and minor vascular complications did not differ significantly according to femoral artery size (17% vs 5%) (p=0.16). The iSleeve sheath was not correlated with any of the complications. The use of the iSleeve sheath was unsuccessful in four patients (5%), of which one patient had a small femoral artery diameter.Conclusion Transfemoral TAVR with the ACURATE neo system using the iSleeve sheath is a promising method for patients with small femoral arteries even though we found a trend towards higher rates of complications in these patients. The use of expandable sheaths may expand the spectrum of patients that can be treated with transfemoral TAVR, and thus may improve the prognosis in patients with severe aortic valve stenosis.All data relevant to the study are included in the article or uploaded as supplementary information.