Simultaneous thoracic aortic endovascular graft and transfemoral transcatheter aortic valve replacement in a patient with a descending aortic thrombus

• Published in: Cardiovascular revascularization medicine 2019-01, Vol.20 (1), p.87-88
• Main Authors: Parikh, Puja B., Loh, Shang, Gruberg, Luis, Weinstein, Jonathan, Tannous, Henry, Bilfinger, Thomas
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - physiopathology; Aorta, Thoracic - surgery; Aortic Diseases - diagnostic imaging; Aortic Diseases - physiopathology; Aortic Diseases - surgery; Aortic stenosis; Aortic thrombus; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Blood Vessel Prosthesis Implantation - instrumentation; Catheterization, Peripheral - methods; Endovascular Procedures - instrumentation; Female; Femoral Artery; Humans; Severity of Illness Index; Thoracic aortic endograft; Thrombosis - diagnostic imaging; Thrombosis - physiopathology; Thrombosis - surgery; Transcatheter Aortic Valve Replacement; Treatment Outcome
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2018.08.012

Severe descending thoracic and abdominal aortic pathology can deter consideration of transfemoral (TF) access for transcatheter aortic valve replacement (TAVR) in adults with severe symptomatic aortic stenosis (AS) and may lead to utilization of alternative access sites. We report a case of an 88-year-old frail woman with severe symptomatic AS referred for TAVR with demonstration of a large thrombus in the descending thoracic aorta immediately distal to the left subclavian artery. Given concerns of thrombus embolization with femoral advancement of the transcatheter valve, coverage with a thoracic aortic endograft was planned immediately prior to the TAVR.