Comprehensive Percutaneous Treatment of Aortic Disease with TAVI and EVAR

Introduction: Patients undergoing transcatheter aortic valve implantation (TAVI) may have concomitant abdominal aortic aneurysms (AAA) which may require treatment with endovascular aortic aneurysm repair (EVAR). We report our institutional experience with performing TAVI in patients with treated or untreated AAA.

Methods: We reviewed our prospective institutional TAVI registry and identified patients with a history of EVAR who subsequently underwent TAVI, and patients who underwent concomitant EVAR and TAVI procedures. All patients underwent thorough pre-procedural workup which included CT-angiograpy. Clinical and procedural data were summarized and follow-up was performed through the computerized Horizon electronic database.

Results: Two patients with a history of EVAR underwent transfemoral TAVI, with implantation of Evolut R and Sapien S3 valves. Vascular closure devices were used in both patients (Proglide). Concomitant transfemoral EVAR and TAVI procedures were performed in two additional patients, with implantation of Evolut R and Sapien S3 valves. One patient underwent EVAR prior to TAVI, and the other underwent TAVI prior to the EVAR. In one of these patients, the femoral vascular access site was closed surgically, and in the second patient the combined procedure was totally percutaneous and access site hemostasis was achieved with Proglide vascular closure devices. All four procedures resulted in optimal function of the prosthetic aortic valves without vascular complications.

Conclusions: TAVI can be safely performed in patients with a history of EVAR. Moreover, performing concomitant EVAR and TAVI procedures is feasible. Thorough patient screening and procedural planning are required, including detailed assessment of the vascular anatomy with CT-angiography.