Concomitant TAVR and EVAR: Treating Two Aortic Diseases With One Percutaneous Procedure

Background: Severe aortic stenosis (AS) and abdominal aortic aneurysm (AAA) involve different segments of the aorta. These life-threatening aortic pathologies can be treated percutaneously using large-bore vascular access, by transcatheter aortic valve replacement (TAVR) and endovascular aneurysm repair (EVAR). Some patients present with both AS and AAA and need to undergo both procedures. Since each procedure may lead to vascular injury, it may be beneficial to perform TAVR and EVAR concomitantly. We present our institutional experience performing combined TAVR and EVAR procedures.

Methods: Our institutional interventional cardiology database documents all TAVR procedures prospectively. Cases of combined TAVR and EVAR were identified and retrospectively analyzed. Clinical and demographic characteristics, procedural variables and clinical outcomes were assessed.

Results: Between 2010-2025, 1318 TAVR procedures were performed at our institute. Eight patients (0.6%) underwent concomitant transfemoral TAVR and EVAR. In all cases TAVR was performed initially, followed immediately by EVAR. Femoral artery vascular access was obtained by surgical cut-down in the initial case. All 7 subsequent cases were performed totally percutaneously, using vascular closure devices to achieve access-site hemostasis. General anesthesia was used in 7 cases and conscious sedation in 1 case. Mean age was 80±7 years, balloon-expandable valves were implanted in 75% of the patients, contrast volume administered was 271±56 ml and fluoroscopy time was 50±13 minutes. Vascular closure device failure occurred in 3 of the 7 percutaneous cases and vascular repair with stent graft implantation was performed successfully in all. Time to hospital discharge was 6±1 days. No patients sustained kidney injury or required subsequent vascular interventions. 30-day mortality was zero and 1-year-mortality was 14%.

Conclusions: Patients who have both AS and AAA may benefit from concomitant percutaneous TAVR and EVAR. Further study is required to validate these findings.