Key result
A staged approach of endovascular aortic aneurysm repair followed by transcatheter aortic valve replacement was feasible and safe, achieving 100% procedural success and 0% 30-day mortality.
Why the study?
The incidence of AAA and its impact on outcomes among patients undergoing TAVR remains unclear, while post-TAVR blood pressure increases raise rupture risk if AAA repair is delayed.
Case Report (n=5)
No
This case series describes the technical and procedural considerations for staged EVAR and TAVR in patients with concomitant severe aortic stenosis and abdominal aortic aneurysm.
Staged EVAR followed by TAVR was feasible in this small series; leaves open optimal sequencing, timing, and safety in broader populations.
Symptomatic aortic valve stenosis (AS) and abdominal aortic aneurysm (AAA) are critical clinical conditions, increasingly more prevalent with aging of the population. Calcific aortic stenosis is the most common structural cardiac disease in the elderly population, and medical management of severe aortic stenosis of the elderly population is associated with poor outcomes as compared to surgical treatment. Transcatheter aortic valve replacement (TAVR) is a treatment of choice in inoperable, often elderly, patients with symptomatic severe AS and in intermediate-to-high surgical risk patients. It is not yet clarified the incidence of AAA and its impact on procedural and clinical outcomes among patients undergoing TAVR. It is known that after AS resolution with aortic valve replacement or TAVR there is an increase in blood pressure that increases the risk of dissection or abdominal aortic aneurysm rupture if AAA repair is delayed. The purpose of this report is to describe the anatomical details and technical and procedural considerations when proposing totally endovascular strategies dedicated to the treatment of patients with AS and AAA.
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Medda et al. (2023) conducted a case report in Severe aortic valve stenosis and abdominal aortic aneurysm (n=5). Staged EVAR and TAVR was evaluated on 30-day mortality. A staged approach of endovascular aortic aneurysm repair followed by transcatheter aortic valve replacement was feasible and safe, achieving 100% procedural success and 0% 30-day mortality.
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