Combined Transcatheter Aortic Valve Replacement and Endovascular Aortic Repair: A Transfemoral Approach Dilemma
Journal Title: Journal of Surgery - Year 2016, Vol 4, Issue 1
Abstract
We report a case of an elderly patient with severe aortic stenosis (AS) too risky for conventional surgery because of comorbidities that included an infrarenal saccular abdominal aortic aneurysm (AAA). The presence of the aneurysm could impact the outcome of transcatheter aortic valve replacement (TAVR) as improved systolic pressure could increase the risk of aneurysm rupture. Transapical and transaortic approaches for TAVR precluded simultaneous endovascular aortic repair (EVAR). Transfemoral approach was the most viable option. Doing EVAR first would circumvent aortic rupture but it could be technically precarious to do EVAR before TAVR when both are done transfemorally. Contrast-induced nephropathy could be considered whether combined procedure is riskier than angiogram-dependent procedures performed in two settings. The patient underwent uncomplicated transfemoral TAVR and then EVAR in one setting. This case underscores the management strategy of a patient with this complicated clinical presentation and underlying pathologies in the light of presently available technologies.
Authors and Affiliations
Wilmo C. Orejola
Keywords
Related Articles
- EP ID EP203806
- DOI 10.13188/2332-4139.1000024
- Views 97
- Downloads 0
The Donor Risk Score: A Simpler Method to Grade Liver Allografts
Context: Growing need for liver transplantation has led to increased efforts to utilize allografts for transplantation from an expanding donor pool (“marginal” donor livers). Objective: To devise a simplified practical...
Therapeutic Ultrasound: Osteoarthritis Symptom-Modification and Potential for Disease Modification
Osteoarthritis (OA) is a degenerative joint disease and a leading cause of adult disability. While joint replacement surgery is a common treatment option for end-stage disease, non-surgical management is critical for pre...
Comparison of J-Shaped Incision and Mercedes Incision for Liver Transplantation
Wound-related and incision-related complications such as wound infections and incisional hernias are common after liver transplantation. Advances in surgical, anesthesiological, critical care, and immunological innovatio...
A Case-Series of Solitary Skull Neoplastic Lesions Treated with En-Block Resection and Complex Cranioplasty
Background and aims: Tumors involving the calvarium but extending into the adjacent scalp layers and/or the underlying dura and brain are technically challenging to treat. Patients often present late in the course of dis...
Trans Oral-Substernum Incision Thoracic Endoscopic Surgery: A Minimally Invasive Endoscopic Approach in Thoracic Surgery
Flexible endoscope is used in Natural Orifice Trans-luminal Endoscopic Surgery. Cervical incision thoracic surgery has recently been described. The use of a flexible endoscope through a natural orifice into the thoracic...