Key result
Patients with concomitant peripheral arterial disease undergoing transcatheter aortic valve replacement face higher risks of vascular complications, but novel techniques and alternative access routes provide feasible treatment options.
Why the study?
Concomitant peripheral arterial disease in severe aortic stenosis patients increases peri-procedural vascular complications and often precludes transfemoral transcatheter aortic valve replacement due to inadequate luminal size.
Novel techniques such as intravascular lithotripsy and alternative vascular access routes enable safe transcatheter aortic valve replacement in patients with severe concomitant peripheral arterial disease.
Aortic stenosis (AS) is a prevalent disease affecting 3.7% of the adult population aged 65 or above. In the past, surgical aortic valve replacement (SAVR) was the only definitive therapy available for the treatment of severe AS. Owing to the invasive nature of open-heart surgery, patients with advanced age and frailty could not benefit from SAVR. The advent of transcatheter aortic valve replacement (TAVR) in the past decade has offered an alternative treatment option for patients with severe AS, particularly those who are deemed to have high surgical risks. Nevertheless, a large proportion of patients also have concomitant peripheral arterial disease (PAD), which increases the risk of peri-procedural vascular complication, and precludes the possibility of transfemoral TAVR owing to inadequate luminal size for delivery system deployment. In this review, the prevalence and outcome of TAVR patients with PAD will be discussed. Furthermore, novel technologies and techniques that enable TAVR to be safely performed using transfemoral or alternative access in patients with severe PAD will be reviewed.
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Wong et al. (2022) conducted a review in Aortic stenosis with concomitant peripheral arterial disease. Transcatheter aortic valve replacement (TAVR) was evaluated. Patients with concomitant peripheral arterial disease undergoing transcatheter aortic valve replacement face higher risks of vascular complications, but novel techniques and alternative access routes provide feasible treatment options.
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