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Aortic stenosis (AS) prevalence increases with the elderly. They present high surgical risk due to the comorbid factors increasing with the age. One of the comorbid factors that increases the risk in patients is aortic aneurysm. It will increase the rupture risk with the systolic pressure which will be increased with the aortic stenosis treated. Hence, the timing and method of the both treatments are of great importance in our high-risk case which is accompanied by thoracic aortic saccular aneurysm and serious aortic stenosis. Transcatheter aortic valve implantation (TAVI) is an effective method in the patients that present severe aortic stenosis with a higher surgical risk or that cannot undergo surgical aortic valve replacement (s-AVR). A 83 years old male patient with a history of coronary artery bypass grafting (CABG), and permanent pacemaker (VVI-R type) following myocardial infarction six years ago was admitted to our clinic as he had an increased dyspnea lately. Transthoracic echocardiography (TTE), severe aortic stenosis were detected and left ventricular ejection fraction (EF) was detected as 35%. Multi-slice computed tomography (MSCT), 20x18 mm saccular aneurysm in the thoracic aorta just after the left subclavian artery was detected by means of a detailed review. Under general anesthesia, the patient who was taken to catheterization laboratory was performed surgical cut-down from left femoral route firstly, he was performed balloon valvuloplasty accompanied with TEE and then Edwards Sapien XT (Edwards Lifesciences, Irvine, CA, USA) 26 mm valve implantation under the rapid pacing through 18 Fr sheath. The procedure was evaluated as successful. Then, the guide catheter was implanted over the stiff wire implanted for TAVI. A 0.035 inch extra-stiff wire through the guiding catheter (Lunderquist, Cook, Inc.) was advanced to the ascending aortic proximal gently enough not to touch the bioprosthesis aortic valve. Then; over the extra-stiff wire, a 36x130 mm Zenith ® (Cook, Inc., Bloomington, Ind.) thoracic stent-graft was placed just distal to the left subclavian artery. Notable improvements in functional capacity was observed in the patient discharged 1 week following the procedure and taken into the follow-up. After 1 month, the patient had good functional capacity and there was no complications control TTE and MSCT.
In this case which is, as far as we know, the first and the only one in the literature; both TAVI and endovascular thoracic aortic saccular aneurysm repair (TEVAR) were applied simultaneously successfully to the patient via same transfemoral route. In this way, we tried to emphasize with a multi disciplinary study that the patients be assessed carefully before the procedure, that even the patients with common peripheral vascular diseases transfemoral route could be used together with the proper methods, and that both procedures could be performed simultaneously.