Transcatheter aortic valve implantation despite challenging vascular access

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Severe aortic stenosis necessitates valve replacement.
• Transcatheter aortic valve implantation (TAVI) is a common treatment for aortic stenosis.
• Severe peripheral artery disease (PAD) can complicate TAVI by limiting vascular access.

Observation:

• A 78-year-old male patient with severe aortic stenosis, comorbidities, and heart failure was evaluated for TAVI.
• The patient had severe PAD, including infrarenal aorta and iliac artery stenosis, precluding standard TAVI access.
• A 23-mm Edwards Sapien valve required a minimum vessel diameter of 7 mm for percutaneous delivery.

Findings:

• Extensive peripheral intervention was performed on the left iliac artery and infrarenal aorta to achieve adequate luminal diameter.
• Successful valve deployment was achieved via the left common femoral artery.
• The transaortic gradient significantly decreased from 40 mmHg to less than 5 mmHg post-procedure.

Implications:

• TAVI can be successfully performed in patients with complex vascular conditions requiring tailored peripheral interventions.
• This case highlights the importance of multidisciplinary collaboration in managing challenging TAVI cases.
• Successful TAVI in patients with severe PAD expands treatment options for this high-risk population.