Peripheral vascular complications during transcatheter aortic valve replacement: management and potential role of chronic steroid use

• Published in: Perspectives in vascular surgery and endovascular therapy Vol. 24; no. 4; p. 206
• Main Authors: Fudim, Marat, Green, Kelly Daniel, Fredi, Joseph L, Robbins, Mark A, Zhao, David
• Format: Journal Article
• Language: English
• Published: United States 01.12.2012
• Subjects: Aged; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - therapy; Asthma - complications; Asthma - drug therapy; Balloon Occlusion; Cardiac Catheterization - adverse effects; Critical Illness; Drug Administration Schedule; Endovascular Procedures - instrumentation; Female; Fibrinolytic Agents - administration & dosage; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Hemorrhage - etiology; Hemorrhage - therapy; Humans; Iliac Artery - diagnostic imaging; Iliac Artery - injuries; Radiography; Risk Factors; Stents; Steroids - administration & dosage; Steroids - adverse effects; Thrombectomy; Thrombolytic Therapy; Thrombosis - etiology; Thrombosis - therapy; Tissue Plasminogen Activator - administration & dosage; Treatment Outcome; Vascular System Injuries - diagnosis; Vascular System Injuries - etiology; Vascular System Injuries - therapy; stent; peripheral; transcatheter aortic valve replacement (TAVR); endovascular; steroids; complications
• ISSN: 1521-5768
• DOI: 10.1177/1531003513491985

To report a case of a major vascular complication during transcatheter aortic valve replacement (TAVR) and the endovascular management thereof. Additionally, we discuss a possible correlation with long-term steroid use. A 79-year-old woman with a history of critical aortic stenosis underwent elective TAVR. Her procedure was complicated by rupture of her right iliac artery, life-threatening retroperitoneal hemorrhage, and thrombus extending into the distal right lower extremity. This case was emergently managed by stent placement, thrombectomy, and tissue plasminogen activator via a percutaneous approach. Peripheral vascular complications are common during percutaneous TAVR, and chronic steroid use may predispose patients. Endovascular management is often possible and may potentially save valuable time in emergent situations.