Iliac Artery Rupture During Transfemoral Transcatheter Aortic Valve Implantation

J INVASIVE CARDIOL 2019;31(7):E229.

Key words: computed tomography angiography, three-dimensional reconstruction, TAVR

An 82-year-old male with severe symptomatic aortic stenosis underwent elective transfemoral transcatheter aortic valve replacement (TAVR). Preprocedural computed tomography angiography revealed marked tortuosity of the femoral and iliac arteries (Figures 1A and 1B). During delivery of a 29 mm Evolut R valve (Medtronic), the patient sustained pulseless activity. The valve was removed and replaced with a 16 Fr sheath. Contrast injection revealed rupture of the proximal iliac artery (Figure 1C). A 12 x 60 mm Fluency stent-graft (Bard Peripheral Vascular) was immediately implanted at the ostium of the iliac artery and the patient received fluid resuscitation as well as infusion of norepinephrine and red blood cells. Following valve delivery via the stent-graft and implantation within the aortic annulus, the patient remained hypotensive; repeat angiography revealed persistent contrast extravasation distal to the site of implantation of the stent-graft. Hemostasis was achieved following implantation of 5 additional overlapping stent-grafts extending to the femoral artery bifurcation (Figure 1D). The patient recovered hemodynamically and was discharged to his home with no adverse clinical sequelae. This case illustrates the feasibility of percutaneous vascular repair following severe vascular injury during TAVR.

From the Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted December 11, 2018.

Address for correspondence: Dr Ronen Jaffe, Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel 34362. Email: jafferonen@gmail.com