Percutaneous Aortic Valve Implantation (TAVI) in a Patient with Severe Peripheral Arterial Disease: A Case Report

Abstract

Background: Trans-Aortic-Valve-Implantation (TAVI) is an innovative technique for the management of patients with symptomatic aortic stenosis. However, it is still associated with a non-negligible rate of vascular complications. In this article we discuss the difficulties of the vascular approach of TAVI. Case Presentation: We report a case of a 72 years old male, hypertensive, chronic smoker, known coronary carrier for 4 years of stenting on the IVA and circumflex with severe aortic stenosis. Admitted for TAVI implantation because of the high surgical risk according to EuroScoreII. Clinical examination note a systolic murmur of aortic stenosis radiating to the neck vessels without signs of heart failure (HF). TTE shows a serrated aortic stenosis (area 0.7cm², mean gradient 58mmHg, Vmax 6m/s). Pre-TAVI arteriography reveals very tight stenosis at the origin of the left primitive iliac artery and tight truncal stenosis of the right primitive iliac artery. Catheterization of the right primitive iliac artery was performed with satisfactory angiographic control. After surgical approach of the right femoral artery and balloon dilatation of the right common iliac artery, crossing of the calcified aortic stenosis with a Terumo guide and AL1 probe, placement of an intra-GV Pitail probe with pressure recording, placement of the SAPIEN 3 prosthesis (23mm), agiographic control showed no para-valvular aortic insufficiency. The postoperative course was straightforward, with no complications noted and a good result on postoperative echocardiography.  Conclusion: Peripheral arterial disease is common in patients undergoing TAVI and is associated with unfavorable early and late clinical outcomes. Assessment of peripheral arterial disease prior to TAVI is crucial not only to determine pathways, but also to prepare for potential vascular complications.