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Avulsed Aortic Atheroma and Aortic Dissection During TAVR With Salvage Bilateral Aortoiliac Stenting
Sumon Roy1, Alexis Lauria2, Rohan Kalathiya2
1Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Division of Cardiology, Boston Medical Center Health System, Boston, Massachusetts, USA.
Insights
Transcatheter aortic valve replacement (TAVR) can cause aortic injury. This case highlights successful management of a rare aortic complication during TAVR using multidisciplinary endovascular techniques.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Background:
- Aortic injury is a serious complication of transcatheter aortic valve replacement (TAVR), occurring in 0.6% to 1.9% of procedures.
- Severe aortic stenosis and peripheral arterial disease increase procedural risks.
Purpose of the Study:
- To report a rare case of catheter-induced avulsed atheroma during TAVR.
- To describe the successful endovascular management of this aortic complication.
Main Methods:
- A patient with severe aortic stenosis and kissing iliac stents underwent TAVR.
- A calcified mass was observed moving with the TAVR catheter during advancement.
- Angiography confirmed a catheter-induced avulsed atheroma without perforation.
Main Results:
- The TAVR catheter was carefully removed, and the atheroma repositioned infrarenally.
- Kissing iliac stenting was performed to cover the mobile plaque.
- Post-procedure angiography demonstrated patent stents and excellent distal aortic and lower extremity runoff.
Conclusions:
- Aortic complications during TAVR, though rare, can be life-threatening.
- Prompt multidisciplinary intervention is crucial for successful endovascular management of such events.
Background:
Aortic injury is a life-threatening complication of transcatheter aortic valve replacement (TAVR), and it occurs in 0.6% to 1.9% of cases.
Case Summary:
An 81-year-old woman with severe aortic stenosis and peripheral arterial disease (kissing iliac stents) presented for TAVR. Mild resistance was encountered when introducing the 14-F TAVR catheter through an 18-F sheath, but the catheter passed with gentle pressure. While the catheter was advancing up the aorta, a large, calcified mass was seen moving with the distal tip. Retraction of the catheter also retracted the seemingly attached calcific mass. Angiography revealed a catheter-induced avulsed atheroma but no perforation.
Discussion:
The TAVR delivery catheter was carefully removed, and the calcific lesion settled infrarenally. Kissing iliac stenting was performed, raising the aortic bifurcation to the juxtarenal aorta and covering the mobile plaque. Angiography showed patent stents with excellent distal aortic and lower extremity runoff.
Take-Home Messages:
Although rare, aortic complications can be devastating. Here, emergency multidisciplinary assistance was critical for a successful endovascular result.
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