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Case Reports
. 2025 Jun 4;30(13):103610.
doi: 10.1016/j.jaccas.2025.103610.

Transaxillary TAVR Complicated by Subclavian Pseudoaneurysm and Vertebral Artery Sacrifice

Caterina Cavazza  1 , Francesco Contorni  2 , Marco Balducelli  3 , Elisa Mikus  4 , Filippo Maioli  5 , Paolo Spath  5 , Salvatore Tarantini  5 , Andrea Santarelli  6 , Fausto Castriota  4 , Mila Menozzi  2 , Nicoletta Franco  2 , Filippo Ottani  2
Affiliations
Case Reports

Transaxillary TAVR Complicated by Subclavian Pseudoaneurysm and Vertebral Artery Sacrifice

Caterina Cavazza et al. JACC Case Rep. .

Abstract

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.

Keywords: TAVR; covered stent; pseudoaneurysm; transaxillary; transsubclavian; vascular complication.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Castriota has served as a proctor for Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Computed Tomography Angiography Assessment of the Femoral Arteries Computed tomography angiography for transcatheter aortic valve replacement planning showing diffuse, severe bilateral calcific disease of the iliofemoral axis.
Figure 2
Figure 2
Computed Tomography Angiography Assessment of the Axillary and Subclavian Arteries Computed tomography angiography for transcatheter aortic valve replacement planning revealing extensive disease affecting both subclavian arteries, with critical, severely calcified stenosis of the left subclavian artery and moderate, mildly calcified, and partially dissected stenosis of the midpart of the right subclavian artery. Avg. = average; RAO = right anterior oblique.
Figure 3
Figure 3
Subclavian Artery Dissection (Left) Angiography of the right subclavian artery after transcatheter aortic valve replacement showing vessel dissection (asterisk). (Right) Sealing of the dissection tear following deployment of a self-expanding stent.
Figure 4
Figure 4
Subclavian Postprocedural Pseudoaneurysm Multiple computed tomography angiography reconstructions of the pseudoaneurysm involving the proximal right subclavian artery (asterisks) and its relationship with close anatomical structures. (A and B) Multiple intensity projection and snake views demonstrating the close relationship with the proximal edge of the stent. (C and D) Volume rendering views illustrating the close relationship with the right vertebral artery (RVA). RCCA = right common carotid artery.
Figure 5
Figure 5
Pseudoaneurysm Treatment (A) Right subclavian artery angiography before endovascular treatment, showing the pseudoaneurysm (asterisk) and the stenosis at the surgical access. (B) Corresponding visualization on computed tomography angiography of the pseudoaneurysm (asterisk). (C) Angiography following placement of 3 overlapped covered stents, demonstrating lesion exclusion. (D) Corresponding visualization on computed tomography angiography of pseudoaneurysm sealing by covered stents. Abbreviations as in Figure 4.
See this image and copyright information in PMC

References

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