case_images: PMC10713811_01
case_images: Coronary artery intervention treatment. The emergency coronary angiography results showed a left-dominant coronary artery, no severe stenosis in the right coronary artery (A), and no significant stenosis in the circumflex branch (B), but acute complete occlusion of the proximal segment of the left anterior descending branch (C). Angiography of the abdominal aorta-iliac artery bifurcation revealed diffuse narrowing of the left femoral artery (intravascular diameter <5 mm) and multiple ulcers and aneurysmal dilatation of the external iliac artery (D); selective angiography of the right iliac artery showed focal stenosis at the bifurcation of the right external-internal iliac artery (E).
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case_images: F1
case_images: CAG was performed via the left femoral artery route (Figures 1A,B). The anterior descending artery was the culprit vessel with proximal acute occlusion, and a 3.5 mm x 23 mm drug-eluting stent was implanted (Figure 1C). The angiography showed diffuse stenosis of the left common femoral artery, multiple ulcers and tumor-like dilatation of the external iliac artery, and limited stenosis of the right external iliac-internal iliac artery with a degree of 70% (Figures 1D,E).
case_images: TEE-measured virtual valve annulus diameter. The TEE-measured virtual aortic valve annulus diameter was 21.5 mm (A); the tricuspid aortic valve leaflets were severely calcified (B); color Doppler ultrasound showed mild-to-moderate aortic valve regurgitation (C).
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case_images: F2
case_images: Transesophageal echocardiography (TEE) indicated that the inner diameter of the aortic valve annulus was 21.5 mm (Figure 2).
case_images: TAVR process. After the 4.0 mm x 20 mm peripheral balloon was sent to the stenosis site of the external-internal iliac artery bifurcation through a 20Fr hydrophilic-coated guiding sheath, balloon angioplasty was performed with 6 atm to dilate the lesion vessel (A). The valve was quickly delivered to the aortic root through the catheter under mechanical chest compressions and was released after proper positioning (B). Aortic angiography showed no paravalvular leaks (C). Selective left coronary angiography indicated good coronary artery visualization (D). Selective right iliac artery angiography confirmed residual stenosis of less than 30% after balloon angioplasty of the stenosis site of the external-internal iliac artery bifurcation, with no local vascular complications such as dissection (E).
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case_images: PMC10713811_01_fcvm-10-1291089-g003.jpg
case_images: F3
case_images: A peripheral balloon was delivered to the external-internal iliac artery bifurcation through a hydrophilic-coated guiding sheath, and lesional balloon angioplasty was performed (Figure 3A). No paravalvular leakage was found using ascending aortography (Figures 3B,C). The selective left CAG showed a well-developed coronary artery (Figure 3D). Angiography of the right iliac artery showed that residual stenosis of the external iliac artery to the internal iliac artery bifurcation was less than 30%, and no local vascular complications such as dissection were found (Figure 3E).