Successful Use of an eSheath for Failed Introduction of the Evolut R Valve during Transfemoral Transcatheter Aortic Valve Implantation

摘要

An 86-year-old man with severe, symptomatic aortic stenosis underwent a 29 mm Evolut R (Medtronic, Minneapolis, MN, USA) implantation using the right femoral artery approach. Pre-procedural computed tomography angiography showed significant tortuosity, but adequate diameters (>7.0 mm) and minimal calcification in both external iliac arteries ( ). After a Lunderquist Extra-Stiff Wire Guide (Cook Medical, Bloomington, IN, USA) was inserted to straighten the anatomy and increase stability, neither the 14Fr Inline nor 18 Fr sheath could be inserted into the right iliac artery due to strong resistance. The angiography showed a severe accordion phenomenon in the right iliac artery that prevented device insertion ( ). To overcome the phenomenon, a 14Fr eSheath (Edwards Lifesciences, Irvine, CA, USA) was successfully inserted with some resistance. A 29 mm Evolut R e-Sheath was then smoothly implanted without any major vascular complications ( ).