Femoro-Femoral Bypass for a Vascular Complication During Transfemoral Aortic Valve Implantation

A 94-year-old woman underwent transcatheter aortic valve implantation (TAVI) for treatment of severe aortic stenosis (AS). Final angiography showed the right external iliac artery occlusion due to vascular injury related to a large-diameter introducer sheath. Although we performed endovascular therapy, no guidewires could cross the culprit lesion because the intima had frapped and occluded the vessel lumen. Therefore, we performed femoro-femoral bypass for bailout of acute limb ischemia. Femoro-femoral bypass is a less invasive, shorter operation time and therefore a reasonable strategy as an urgent bailout for vascular complications during TAVI in super-aged or higher-risk surgical patients with severe AS.