Simultaneous TAVR and EVAR for Severe Aortic Regurgitation With Giant Abdominal Aortic Aneurysm

We present an older male with severe aortic regurgitation scheduled for transcatheter aortic valve replacement (TAVR). Preoperative imaging identified a giant eccentric abdominal aortic aneurysm at high risk of rupture. This risk was mitigated by a single-stage combined procedure of TAVR and endovascular aneurysm repair.

Two 8-F sheaths were respectively inserted into the bilateral femoral arteries. We then sequentially dilated the right femoral artery access using 14-F, 18-F, and 20-F introducer sheaths. The self-expanding stent system Endurant II was inserted and released. Coronary angiography assessed the degree of coronary artery stenosis. A 20-F sheath was inserted into the right femoral artery, and then we deployed the Evolut Pro + prosthetic valve.

Potential pitfalls include the following: paravalvular leakage, valve displacement or detachment, and rupture of aneurysms.

For surgical high-risk patients with concurrent abdominal aortic aneurysm and severe aortic valve disease, the simultaneous implementation of TAVR and endovascular aneurysm repair may represent a viable therapeutic option.