Femoral transcatheter aortic valve implantation (TAVI) is usually done by surgical cut down under general anesthesia. Complete percutaneous approach has become widely accepted in endovascular management of aortic disease, and we have decided to apply this technique for TAVI. We aimed to evaluate the impact of the sheath size on safety and efficacy of this technique.The study cohort included 64 consecutive patients who underwent femoral approach using Prostar XL device at our institution between Mar 2008 and Feb 2010. The cohort was divided into two groups: group 1, 18 or 19 Fr sheath (1 Prostar XL device) and group 2, 22 or 24Fr (2 Prostar XL). The iliac and femoral angiogram was obtained before insertion and after removal of the sheath using contralateral approach. Device success was defined as immediate hemostasis without surgery or death related to access site during hospital stay.Clinical characteristics were similar in both groups (83.6±5.7 years, male gender 50% and logistic Euroscore 25.3±11.0%) besides higher rate of hypertension (81.0% vs 56.1%; p=0.03) in group 1.In group 1, Corevalve was used in 14 cases and Edwards valve in 9 cases. In group 2, 22 Fr sheath was used in 22 cases and 24Fr in 19.The angiogram showed smaller femoral artery diameter in group 1 (7.7±1.2 vs 9.0±0.9mm; p=0.001 and common iliac artery 9.4±1.4 vs 11.5±1.8mm; p=0.001), a lower calcium score (0.6±0.8 vs 1.1±0.7; p=0.034) and tortuosity score (0.6±0.7 vs 1.2±0.7; p=0.001). Device success was achieved in 100% in group 1 and 95.1% in group 2 (p=ns).The rate of iliac artery perforation or rupture was lower in group 1 (0% vs 9.8%; p=0.044). Death due to access site complication was observed only in 1 case in group 2 (p=ns).Thanks to the development of lower profile devices, percutaneous approach for femoral arterial access is emerging as a promising method for TAVI and will decrease the need for general anesthesia in this high risk patients.