Key result
Emergent endovascular aneurysm repair was successfully performed for a ruptured abdominal aortic aneurysm one month post-TAVR, but the patient died five days later from pulseless electrical activity arrest.
Why the study?
Up to 10% of patients screened for transcatheter aortic valve replacement present with an abdominal aortic aneurysm, prompting review of simultaneous endovascular aneurysm repair to potentially improve outcomes.
Case Report (n=1)
Answers are grounded in this paper and cite their sources.
This case highlights the potential risk of AAA rupture shortly after TAVR and suggests that simultaneous EVAR and TAVR may be considered in select patients to improve outcomes.
Background: Transcatheter aortic valve replacement is an important procedure with the aging US population presenting with more aortic stenosis and as many as 10 % of these patients presenting with an abdominal aortic aneurysm at the time of screening. This procedure has also been shown to be as safe as open aortic valve replacement with lower risks of death, stroke, and rehospitalization. Case Report: A 91-year-old female presents approximately one month after transcatheter aortic valve with an acute retroperitoneal rupture of a known abdominal aortic aneurysm. The patient was taken for an emergent endovascular aortic aneurysm repair and became suddenly unresponsive and apneic prior to any anesthetic drug administration, the patient was intubated, and rapid transfusion was started. The procedure was completed successfully with immediate improvement in the patient’s vitals after deployment of the stent. The patient was recovering well, but five days later had a sudden pulseless electrical activity arrest and after appropriate but unsuccessful advanced cardiac life support was declared deceased. Conclusion: While not standard of care, a simultaneous endovascular aneurysm repair during transcatheter aortic valve repair in select patients seems to be a safe procedure without increase in complications from either procedure completed separately. The aim of this manuscript is to review the recent success of simultaneous repair and to illustrate that this newer method may improve outcomes.
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Michael Trostler (2021) conducted a case report in Ruptured Abdominal Aortic Aneurysm after Transcatheter Aortic Valve Replacement (n=1). Emergent endovascular aneurysm repair (EVAR) was evaluated on Clinical outcome. Emergent endovascular aneurysm repair was successfully performed for a ruptured abdominal aortic aneurysm one month post-TAVR, but the patient died five days later from pulseless electrical activity arrest.
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