Abstract
A 68-year-old man with ischemic cardiomyopathy presented with critical aortic stenosis and Society for Cardiovascular Angiography and Interventions stage D cardiogenic shock. Because of occluded bilateral femoral vasculature, a right axillary single-access Impella balloon aortic valvuloplasty approach was successfully performed, improving the patient's cardiac index from 1.5 to 2.5 L/min/m(2). This case highlights the use of pre-intravascular ultrasound imaging, the "dry-exchange" technique to enhance safety, and single-access Impella balloon aortic valvuloplasty to maintain cardiac output during repeated prolonged balloon inflations.