Transcatheter Balloon Expandable Aortic Valve Implantation through an Aortofemoral Bypass Graft

An 84-year-old woman was diagnosed with symptomatic severe aortic stenosis. She had previously undergone aortobifemoral bypass grafting (Y graft) for bilateral iliac stenosis. In view of a high surgical risk, a decision for transcatheter aortic valve implantation (TAVI) was made. An incision was made on the right limb of the Y graft and subsequently a 16 Fr e-sheath was smoothly advanced through the graft. A 23 mm balloon expandable valve was then advanced with no resistance and successfully deployed. This case highlights the feasibility of TAVI through the graft, but requires a thorough preprocedural assessment of the access route using multiple imaging modalities.