Peripheral vascular complications during transcatheter aortic valve replacement: management and potential role of chronic steroid use

Perspect Vasc Surg Endovasc Ther. 2012 Dec;24(4):206-9. doi: 10.1177/1531003513491985. Epub 2013 Jun 21.

Abstract

Purpose: To report a case of a major vascular complication during transcatheter aortic valve replacement (TAVR) and the endovascular management thereof. Additionally, we discuss a possible correlation with long-term steroid use.

Case report: A 79-year-old woman with a history of critical aortic stenosis underwent elective TAVR. Her procedure was complicated by rupture of her right iliac artery, life-threatening retroperitoneal hemorrhage, and thrombus extending into the distal right lower extremity. This case was emergently managed by stent placement, thrombectomy, and tissue plasminogen activator via a percutaneous approach.

Conclusions: Peripheral vascular complications are common during percutaneous TAVR, and chronic steroid use may predispose patients. Endovascular management is often possible and may potentially save valuable time in emergent situations.

Keywords: complications; endovascular; peripheral; stent; steroids; transcatheter aortic valve replacement (TAVR).

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aortic Valve Stenosis / complications
  • Aortic Valve Stenosis / diagnosis
  • Aortic Valve Stenosis / therapy*
  • Asthma / complications
  • Asthma / drug therapy*
  • Balloon Occlusion
  • Cardiac Catheterization / adverse effects*
  • Critical Illness
  • Drug Administration Schedule
  • Endovascular Procedures* / instrumentation
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Heart Valve Prosthesis Implantation / adverse effects*
  • Heart Valve Prosthesis Implantation / methods
  • Hemorrhage / etiology
  • Hemorrhage / therapy
  • Humans
  • Iliac Artery / diagnostic imaging
  • Iliac Artery / injuries*
  • Radiography
  • Risk Factors
  • Stents
  • Steroids / administration & dosage
  • Steroids / adverse effects*
  • Thrombectomy
  • Thrombolytic Therapy
  • Thrombosis / etiology
  • Thrombosis / therapy
  • Tissue Plasminogen Activator / administration & dosage
  • Treatment Outcome
  • Vascular System Injuries / diagnosis
  • Vascular System Injuries / etiology
  • Vascular System Injuries / therapy*

Substances

  • Fibrinolytic Agents
  • Steroids
  • Tissue Plasminogen Activator