Management of severe symptomatic aortic stenosis and concomitant large abdominal aortic aneurysm in high-risk patients: Review of literature and case series

Background Transcatheter aortic valve replacement (TAVR) has become the traditional standard of care for patients with severe symptomatic aortic stenosis (AS) at high surgical risk, but recently it has been increasingly used for treating patients with intermediate as well as low operative risk. Endovascular aneurysm repair (EVAR) is generally the first-line strategy for treating abdominal aortic aneurysms (AAAs) particularly for infrarenal AAAs meeting the anatomical necessary criteria. The association between AS and AAA is increasing due to the increased life expectancy. Only a limited number of combined TAVR and EVAR procedures have been reported in the literature, each utilizing different strategies and device choices tailored to individual patient anatomy and risk profiles. In the absence of clear clinical guidelines, several challenges remain in identifying the optimal management approach for patients with both severe AS and AAA. Objective This paper explores the current trends in the treatment of patients with severe symptomatic AS and concomitant large infrarenal AAA, particularly in those at high surgical risk. We present two representative cases managed with a combined TAVR and EVAR approach, highlighting the procedural advantages and risks and decision-making challenges. The implementation of this innovative, minimally invasive strategy may in some cases significantly reduce both hospitalization time and periprocedural complications. Conclusion With growing clinical experience, this combined approach may evolve into a standard of care for carefully selected high-risk individuals.