Successful management of a bleeding complication during transaxillary transcatheter aortic-valve implantation: a case...

The axillary artery is an alternative access route for transcatheter aortic-valve implantation (TAVI) in patients who have unfavourable femoral arteries as well as comorbidities which preclude surgery. Transaxillary TAVI (TAx-TAVI), with a complete non-transfemoral approach, is a feasible and safe alternative even if complications like vascular closure device failure with bleeding occurs.

We describe here a simplified non-transfemoral TAx-TAVI approach in a 71-year-old patient with pulmonary oedema due to severe symptomatic aortic stenosis with a prohibitively high surgical risk (Society of Thoracic Surgeons Mortality 11.9%) and extensive peripheral artery disease that rendered the femoral arteries unsuitable for access. Importantly, this strategy also allows for successful management of bleeding events, particularly those associated with vascular closure device failure, by the use of a new covered stent device. The patient was discharged on Day 6 after admission in stable conditions. In short-term follow-up (30 days), he is asymptomatic with normal left-ventricular function.

The TAx-TAVI is a promising alternative to transfemoral TAVI approach. Patient safety, even during bleeding complications, can be guaranteed with appropriate preparation.