Alternative strategy for TAVR in the context of limited peripheral vascular access: a case report.

Abstract

Background: Severe aortic valve stenosis (AS) has become one of the leading causes of mortality in elderly patients. Currently, transcatheter aortic valve replacement (TAVR) has emerged as a crucial treatment strategy for patients with severe AS. However, numerous patients face difficulties receiving TAVR procedure due to individual patient characteristics and peripheral vascular conditions.

Case report: We present a case report of an elderly patient with low body weight and low-risk severe AS. In this patient, the peripheral blood vessels, particularly both iliac arteries, exhibited a notably small diameter throughout. Additionally, the aortic valve area was reduced, with valve leaflets severely calcified, significantly compromising their mobility. The patient opted for TAVR procedure. However, the traditional femoral-iliac approach for TAVR was constrained by the patient's peripheral vasculature and low BMI. Consequently, we established an artificial vascular-common iliac artery pathway as the primary access route for completing the procedure. Intraoperatively, the retrograde guidewire failed to traverse the patient's valve. As a result, an antegrade approach was adopted in combination with an in vitro guidewire capture technique, and ultimately, the TAVR operation was completed.

Conclusion: Our case demonstrates an innovative interventional treatment strategy for TAVR in patients with severe AS, peripheral vascular limitations, and a low BMI, for whom retrograde wire passage through the valve is not feasible.