Avulsed Aortic Atheroma and Aortic Dissection During TAVR With Salvage Bilateral Aortoiliac Stenting

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BACKGROUND: Aortic injury is a life-threatening complication of transcatheter aortic valve replacement (TAVR), and it occurs in 0.6% to 1.9% of cases. CASE SUMMARY: An 81-year-old woman with severe aortic stenosis and peripheral arterial disease (kissing iliac stents) presented for TAVR. Mild resistance was encountered when introducing the 14-F TAVR catheter through an 18-F sheath, but the catheter passed with gentle pressure. While the catheter was advancing up the aorta, a large, calcified mass was seen moving with the distal tip. Retraction of the catheter also retracted the seemingly attached calcific mass. Angiography revealed a catheter-induced avulsed atheroma but no perforation. DISCUSSION: The TAVR delivery catheter was carefully removed, and the calcific lesion settled infrarenally. Kissing iliac stenting was performed, raising the aortic bifurcation to the juxtarenal aorta and covering the mobile plaque. Angiography showed patent stents with excellent distal aortic and lower extremity runoff. TAKE-HOME MESSAGES: Although rare, aortic complications can be devastating. Here, emergency multidisciplinary assistance was critical for a successful endovascular result.

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