Why the study?
To describe the endovascular management of multiple vessel-related complications during transcatheter aortic valve replacement through surgical right transaxillary access.
Case Report (n=1)
Endovascular intervention is a feasible strategy for managing severe vascular complications, such as subclavian pseudoaneurysm, following transaxillary TAVR.
Endovascular subclavian repair may be feasible in transaxillary TAVR; single-case data leave open questions of safety and generalizability.
OBJECTIVES: We describe the endovascular management of multiple vessel-related complications in a case of transcatheter aortic valve replacement (TAVR) through surgical right transaxillary access. KEY STEPS: We present the case of a TAVR performed through the right transaxillary approach and detail the treatment of an early subclavian dissection and a subacute subclavian pseudoaneurysm, successfully managed through endovascular interventions. POTENTIAL PITFALLS: Significant subclavian disease can raise the questions whether to prepare the vessel before the procedure and whether to proceed sheathless with the valve delivery system or use a larger fixed introducer. Additionally, the decision to treat or not treat early vessel complications may lead to different outcomes. TAKE-HOME MESSAGES: The right transaxillary approach for TAVR is a feasible alternative access, although vascular injuries can occur. A subclavian pseudoaneurysm can be addressed with percutaneous intervention. In this scenario, loss of the ipsilateral vertebral artery can be tolerated without serious consequences.
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Cavazza et al. (2025) conducted a case report in Severe aortic stenosis (n=1). Right transaxillary TAVR and endovascular pseudoaneurysm repair was evaluated.
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