Publication Date
4-1-2015
Journal
The Texas Heart Journal
DOI
10.14503/THIJ-13-4383
PMID
25873826
Publication Date(s)
April 2015
Language
English
PMCID
PMC4382881
PubMedCentral® Posted Date
4-1-2015
PubMedCentral® Full Text Version
Post-Print
Published Open-Access
yes
Keywords
Aortic valve stenosis/therapy, catheterization, peripheral/adverse effects, endovascular procedures, heart valve prosthesis implantation/instrumentation/methods, patient selection, peripheral arterial disease/complications/therapy, risk factors, stents, treatment outcome, ultrasonography, interventional
Copyright
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Abstract
We describe transcatheter aortic valve implantation in a patient who had severe peripheral artery disease. The patient's vascular condition required additional preliminary peripheral intervention to enable adequate vascular access.
A 78-year-old man with severe aortic stenosis, substantial comorbidities, and severe heart failure symptoms was referred for aortic valve replacement. The patient's 20-mm aortic annulus necessitated the use of a 23-mm Edwards Sapien valve inserted through a 22F sheath, which itself needed a vessel diameter of at least 7 mm for percutaneous delivery. The left common femoral artery was selected for valve delivery. The left iliac artery and infrarenal aorta underwent extensive intervention to achieve an intraluminal diameter larger than 7 mm. After aortic valvuloplasty, valve deployment was successful, and the transaortic gradient decreased from 40 mmHg to less than 5 mmHg. The patient was discharged from the hospital 4 days postoperatively. We conclude that transcatheter aortic valve implantation can be successfully performed in patients with obstructed vascular access, including stenosis of the infrarenal aorta and the subclavian and coronary arteries.