title: Peripheral vascular complications during transcatheter aortic valve replacement: management and potential role of chronic steroid use.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: 1Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Marat
authors.initials: M
authors.lastname: Fudim
authors.forename: Kelly Daniel
authors.initials: KD
authors.lastname: Green
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Fredi
authors.forename: Mark A
authors.initials: MA
authors.lastname: Robbins
authors.forename: David
authors.initials: D
authors.lastname: Zhao
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D001249:Asthma / Q000150:complications / Q000188:drug therapy*; D021721:Balloon Occlusion; D006328:Cardiac Catheterization / Q000009:adverse effects*; D016638:Critical Illness; D004334:Drug Administration Schedule; D057510:Endovascular Procedures / Q000295:instrumentation; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D011859:Radiography; D012307:Risk Factors; D015607:Stents; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects*; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000209:etiology / Q000628:therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*
chemical_list: D005343:Fibrinolytic Agents; D013256:Steroids; D010959:Tissue Plasminogen Activator
keywords: complications; endovascular; peripheral; stent; steroids; transcatheter aortic valve replacement (TAVR)