Combined Transcatheter Aortic Valve Replacement and Endovascular Aortic Repair: A Transfemoral Approach Dilemma

We report a case of an elderly patient with severe aortic stenosis (AS) too risky for conventional surgery because of comorbidities that included an infrarenal saccular abdominal aortic aneurysm (AAA). The presence of the aneurysm could impact the outcome of transcatheter aortic valve replacement (TAVR) as improved systolic pressure could increase the risk of aneurysm rupture. Transapical and transaortic approaches for TAVR precluded simultaneous endovascular aortic repair (EVAR). Transfemoral approach was the most viable option. Doing EVAR first would circumvent aortic rupture but it could be technically precarious to do EVAR before TAVR when both are done transfemorally. Contrast-induced nephropathy could be considered whether combined procedure is riskier than angiogram-dependent procedures performed in two settings. The patient underwent uncomplicated transfemoral TAVR and then EVAR in one setting. This case underscores the management strategy of a patient with this complicated clinical presentation and underlying pathologies in the light of presently available technologies.