Staged Hybrid Treatment of Acute Type B Complicated Aortic and External Iliac Artery Dissection and Femoral Occlusion after Transcatheter Aortic Valve Implantation

Abstract

Percutaneous aortic valve replacement (TAVI) has become the treatment of choice for elderly patients with severe aortic valve stenosis because of its less invasive nature compared to surgery. As TAVI is increasingly offered, issues such as vascular lesions, access site problems, paravalvular leaks, and aortic dissection (AD) are a few associated complications, needing consideration. AD after TAVI is rare but serious, occurring in 0.2% to 0.3% of cases, with both intraprocedural and late cases reported. This case study concerns a 68-year-old woman who developed Stanford B AD, external iliac artery dissection, and right common femoral artery occlusion after TAVI. Treatment included the stenting of the iliac and common femoral arteries, followed by a staged procedure: debranching, thoracic endovascular aortic repair (TEVAR), and endovascular aneurysm repair (EVAR), with satisfactory results. This case underscores the importance of vigilance in the management of TAVI-related complications to optimize patient care and outcomes.