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Transaxillary TAVR Complicated by Subclavian Pseudoaneurysm and Vertebral Artery Sacrifice
Caterina Cavazza1, Francesco Contorni1, Marco Balducelli2
1Emergency and Cardiology Department, Infermi Hospital Rimini, Romagna Local Health Authority, Rimini, Italy.
Objectives:
We describe the endovascular management of multiple vessel-related complications in a case of transcatheter aortic valve replacement (TAVR) through surgical right transaxillary access.
Key Steps:
We present the case of a TAVR performed through the right transaxillary approach and detail the treatment of an early subclavian dissection and a subacute subclavian pseudoaneurysm, successfully managed through endovascular interventions.
Potential Pitfalls:
Significant subclavian disease can raise the questions whether to prepare the vessel before the procedure and whether to proceed sheathless with the valve delivery system or use a larger fixed introducer. Additionally, the decision to treat or not treat early vessel complications may lead to different outcomes.
Take-Home Messages:
The right transaxillary approach for TAVR is a feasible alternative access, although vascular injuries can occur. A subclavian pseudoaneurysm can be addressed with percutaneous intervention. In this scenario, loss of the ipsilateral vertebral artery can be tolerated without serious consequences.
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