Renal Artery Perforation During Transcatheter Aortic Valve Replacement

Q4 Medicine

JACC. Case reports Pub Date : 2025-10-08 DOI:10.1016/j.jaccas.2025.105299

Saleh Altaf MD, Hammad Shafique MD, Alexander Tindale MD, Konstantinou Konstantinos MD, Tito Kabir MD

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Abstract

Background

Transcatheter aortic valve replacement (TAVR) is a well-established modality to treat severe aortic stenosis.

Case Summary

We report a case of a woman in her 70s who underwent TAVR. The procedure was complicated owing to right renal artery perforation by a 0.038-inch angled-tip hydrophilic guidewire during closure of the left femoral artery, requiring implantation of a covered stent in renal artery to achieve hemostasis.

Discussion

In cases of shock during TAVR, injury to nonaccess site vessels should be considered. Treatment of iatrogenic renal artery injury with covered stent deployment achieves rapid hemostasis and preserves kidney function.

Take-Home Messages

In case of periprocedural hemorrhagic shock during TAVR, injury to nonaccess site vessels should be considered. Meticulous fluoroscopic guidance should always be used when advancing guidewires to prevent vascular damage. Awareness of patient-specific anatomical variation of arteries can help the operator to be more cautious and avoid entering that artery.

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经导管主动脉瓣置换术中肾动脉穿孔

背景：经导管主动脉瓣置换术（TAVR）是治疗严重主动脉瓣狭窄的一种行之有效的方法。我们报告一位70多岁妇女接受TAVR手术的病例。在左股动脉闭合过程中，0.038英寸角尖亲水导丝刺穿右肾动脉，手术较为复杂，需要在肾动脉内植入覆盖支架止血。在TAVR期间发生休克的情况下，应考虑对不可进入部位血管的损伤。覆盖支架置放治疗医源性肾动脉损伤，可快速止血，保护肾功能。如果TAVR术中发生失血性休克，应考虑非通路部位血管的损伤。在推进导丝时，应始终使用细致的透视引导，以防止血管损伤。了解患者特定的动脉解剖变化可以帮助手术者更加谨慎，避免进入该动脉。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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