In recognition of the excellent outcomes achieved with transfemoral access, the use of transcathter aortic valve replacement (TAVR) has skyrocketed in recent years. There are now more TAVR than surgical aortic valve (AVR) procedures done for isolated aortic stenosis (AS) in the United States each year, and the proportion is expected to further rise as the use of TAVR expands in low-risk patients . Percutaneous transfemoral access is considered the gold standard for TAVR, given better outcomes in comparison to all alternative access strategies and surgical cut-down approaches in randomized controlled trials and large observational studies . While major vascular complications occur after ~2–3% of transfemoral TAVR cases, data support attempting transfemoral access even in borderline cases, as regardless of whether peripheral intervention is needed to facilitate sheath passage or bailout intervention is needed after TAVR, outcomes are still likely superior to non-femoral alternative access approaches .