Tips and Tricks for Successful Trans-EVAR TAVR: Buddy up!

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Vascular Surgery

Background:

• Trans-catheter aortic valve replacement (TAVR) is a critical procedure for aortic stenosis.
• Prior endovascular aneurysm repair (EVAR) presents unique challenges for TAVR access.
• Tortuous iliofemoral vessels complicate standard TAVR approaches.

Observation:

• This case report details a TAVR procedure performed via severely tortuous iliofemoral arteries in a patient with a history of EVAR.
• Pre-procedural planning was essential to anticipate and navigate anatomical difficulties.
• Four specific strategies were employed to successfully manage the challenging access route.

Findings:

• Detailed imaging and planning allowed for successful navigation of the tortuous iliofemoral access.
• The implementation of four distinct procedural strategies mitigated risks associated with trans-EVAR TAVR.
• The TAVR device was successfully deployed, achieving a favorable procedural outcome.

Implications:

• These strategies offer a potential framework for managing complex TAVR cases in patients with prior EVAR.
• Successful TAVR in challenging anatomies can expand treatment options for high-risk patients.
• Further research into standardized approaches for trans-EVAR TAVR is warranted to improve procedural success rates.