Transaxillary TAVR Complicated by Subclavian Pseudoaneurysm and Vertebral Artery Sacrifice.

OBJECTIVES

We describe the endovascular management of multiple vessel-related complications in a case of transcatheter aortic valve replacement (TAVR) through surgical right transaxillary access.

KEY STEPS: We present the case of a TAVR performed through the right transaxillary approach and detail the treatment of an early subclavian dissection and a subacute subclavian pseudoaneurysm, successfully managed through endovascular interventions.

POTENTIAL PITFALLS: Significant subclavian disease can raise the questions whether to prepare the vessel before the procedure and whether to proceed sheathless with the valve delivery system or use a larger fixed introducer. Additionally, the decision to treat or not treat early vessel complications may lead to different outcomes.

TAKE-HOME MESSAGES: The right transaxillary approach for TAVR is a feasible alternative access, although vascular injuries can occur. A subclavian pseudoaneurysm can be addressed with percutaneous intervention. In this scenario, loss of the ipsilateral vertebral artery can be tolerated without serious consequences.