ICE-Guided False Lumen Occlusion Following Combined TAVR and TEVAR

BACKGROUND: Concomitant severe aortic stenosis and descending aortic pathology pose unique challenges for transcatheter treatment strategies.

CASE SUMMARY: A 75-year-old man with end-stage renal disease and chronic descending aortic dissection presented with symptomatic severe aortic stenosis. Preprocedural imaging revealed a heavily calcified aortic valve and a large thoracic aortic aneurysm with dissection. He underwent successful transfemoral transcatheter aortic valve replacement using a 65-cm-long DrySeal sheath, immediately followed by thoracic endovascular aortic repair. Two weeks later, residual false lumen perfusion was treated with a custom-made false lumen occluder under intracardiac echocardiography guidance. The patient recovered uneventfully.

DISCUSSION: This case illustrates the feasibility and potential advantages of simultaneous transfemoral transcatheter aortic valve replacement and thoracic endovascular aortic repair in the setting of complex aortic pathology. It also underscores the emerging and pivotal role of intracardiac echocardiography in guiding endovascular interventions. Such combined strategies may help minimize access-related complications and contribute to favorable clinical outcomes.