Endovascular Management of External Iliac “Snowplowing” Using “Reverse Snowplow” Technique During Transcatheter Aortic Valve Replacement

Veronica Ricker; Hunter Row; Anyamaria Edwards; Johnathan Beaudrie; Cornelius Dyke; Thomas Haldis

doi:doi:10.11648/j.ccr.20230701.11

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Endovascular Management of External Iliac “Snowplowing” Using “Reverse Snowplow” Technique During Transcatheter Aortic Valve Replacement

Veronica Ricker, Hunter Row, Anyamaria Edwards, Johnathan Beaudrie, Cornelius Dyke, Thomas Haldis

Published in Cardiology and Cardiovascular Research (Volume 7, Issue 1)

Received: 19 December 2022 Accepted: 6 January 2023 Published: 17 January 2023

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Abstract

This case describes an 84-year-old female with chronic diastolic heart failure, coronary artery disease status post coronary artery bypass and percutaneous coronary intervention, hypertension, diabetes mellitus and chronic kidney disease stage III, who presented with progressive dyspnea found to have severe aortic stenosis demonstrated by echocardiogram (aortic valve area, .06 ^cm2; mean gradient, 42 mm Hg). She was evaluated by the Heart Team and deemed to be a candidate for a transfemoral transcatheter aortic valve replacement (TAVR) after computed tomography angiography (CTA) evaluation. During insertion of the valve sheath through the external iliac, intimal “snowplowing” occurred resulting in complete occlusion of the iliac artery. The intima was successfully milked back into anatomical position using a “reverse snowplow” technique. Extravasation was managed with covered stents. The patient recovered over several days and was discharged home on post-procedure day 7. When appropriate, Endovascular management of vascular complications avoids the morbidity associated with open repair. Pre-operative evaluation is imperative in identifying anatomical features that pose a risk to vascular complications. This patient had an increased risk with an elevated iliofemoral tortuosity score, however, had minimal calcification and no acute angulation in the iliofemoral arterial system. This case highlights the complexity of vascular complication management and difficulty faced in identifying patients who are at risk for these types of complications.

Published in	Cardiology and Cardiovascular Research (Volume 7, Issue 1)
DOI	10.11648/j.ccr.20230701.11
Page(s)	1-4
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Aortic Stenosis, Structural Heart Disease, Cardiovascular Health

References

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[3]	Kouvelos GN, Papas NK, Arnaoutoglou EM, et. al. Endovascular repair of profunda femoral artery false aneurysms using covered stents. Vascular. 2011 Feb; 19 (1): 51-4. doi: 10.1258/vasc.2010.cr0224. PMID: 21489928.
[4]	De Troia A, Tecchio T, Azzarone M, et. al. Endovascular treatment of an innominate artery iatrogenic pseudoaneurysm following subclavian vein catheterization. Vasc Endovascular Surg. 2011 Jan; 45 (1): 78-82. doi: 10.1177/1538574410388308. PMID: 21193466.
[5]	Anaya-Ayala JE, Charlton-Ouw KM, Kaiser CL, Peden EK. Successful emergency endovascular treatment for superior vena cava injury. Ann Vasc Surg. 2009 Jan-Feb; 23 (1): 139-41. doi: 10.1016/j.avsg.2008.02.016. Epub 2008 May 27. PMID: 18504098.
[6]	Baltacioğlu F, Cimşit NC, Cil B, et. al. Endovascular stent-graft applications in latrogenic vascular injuries. Cardiovasc Intervent Radiol. 2003 Sep-Oct; 26 (5): 434-9. doi: 10.1007/s00270-003-0038-5. PMID: 14753300.
[7]	White R, Krajcer Z, Johnson M, et. al. Results of a multicenter trial for the treatment of traumatic vascular injury with a covered stent. J Trauma. 2006 Jun; 60 (6): 1189-95; discussion 1195-6. doi: 10.1097/01.ta.0000220372.85575.e2. PMID: 16766960.
[8]	Toggweiler S, Leipsic J, Binder R, et al. Management of Vascular Access in Transcatheter Aortic Valve Replacement. J Am Coll Cardiol Intv. 2013 Aug, 6 (8) 767–776. https://doi.org/10.1016/j.jcin.2013.05.004
[9]	Chatziioannou, A., Mourikis, D., Katsimilis, J. et al. Acute Iliac Artery Rupture: Endovascular Treatment. Cardiovasc Intervent Radiol 30, 281–285 (2007). https://doi.org/10.1007/s00270-005-0357-9
[10]	Mach M, Poschner T, Hasan W, et. al. The Iliofemoral tortuosity score predicts access and bleeding complications during transfemoral transcatheter aortic valve replacement: DataData from the VIenna Cardio Thoracic aOrtic valve registrY (VICTORY). Eur J Clin Invest. 2021 Jun; 51 (6): e13491. doi: 10.1111/eci.13491. Epub 2021 Feb 2. PMID: 33432599; PMCID: PMC8243921.
[11]	Lux A, Müllenberg L, Veenstra LF, et. al. Iliofemoral Tortuosity Increases the Risk of Access-Site-Related Complications After Aortic Valve Implantation and Plug-Based Access-Site Closure. CJC Open. 2022 Mar 19; 4 (7): 609-616. doi: 10.1016/j.cjco.2022.03.006. PMID: 35865026; PMCID: PMC9294987.
[12]	Langouet Q, Martinez R, Saint-Etienne C, et. al. Incidence, predictors, impact, and treatment of vascular complications after transcatheter aortic valve implantation in a modern prospective cohort under real conditions. J Vasc Surg. 2020 Dec; 72 (6) 2120-2129.e2. doi: 10.1016/j.jvs.2020.03.035. Epub 2020 Apr 8. PMID: 32276023.
[13]	Hammer Y, Landes U, Zusman O, et. al. Iliofemoral artery lumen volume assessment with three dimensional multi-detector computed tomography and vascular complication risk in transfemoral transcatheter aortic valve replacement. J Cardiovasc Comput Tomogr. 2019 Jan-Feb; 13 (1): 68-74. doi: 10.1016/j.jcct.2018.10.009. Epub 2018 Oct 13. PMID: 30340961.
[14]	Ciurică S, Lopez-Sublet M, Loeys BL, et. al. Arterial Tortuosity. Hypertension. 2019 May; 73 (5): 951-960. doi: 10.1161/HYPERTENSIONAHA.118.11647. PMID: 30852920.
[15]	Généreux P, Piazza N, et al. Valve Academic Research Consortium 3: Updated Endpoint Definitions for Aortic Valve Clinical Research. J Am Coll Cardiol. 2021 Jun, 77 (21) 2717–2746. https://doi.org/10.1016/j.jacc.2021.02.038

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APA Style

Veronica Ricker, Hunter Row, Anyamaria Edwards, Johnathan Beaudrie, Cornelius Dyke, et al. (2023). Endovascular Management of External Iliac “Snowplowing” Using “Reverse Snowplow” Technique During Transcatheter Aortic Valve Replacement. Cardiology and Cardiovascular Research, 7(1), 1-4. https://doi.org/10.11648/j.ccr.20230701.11

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ACS Style

Veronica Ricker; Hunter Row; Anyamaria Edwards; Johnathan Beaudrie; Cornelius Dyke, et al. Endovascular Management of External Iliac “Snowplowing” Using “Reverse Snowplow” Technique During Transcatheter Aortic Valve Replacement. Cardiol. Cardiovasc. Res. 2023, 7(1), 1-4. doi: 10.11648/j.ccr.20230701.11

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AMA Style

Veronica Ricker, Hunter Row, Anyamaria Edwards, Johnathan Beaudrie, Cornelius Dyke, et al. Endovascular Management of External Iliac “Snowplowing” Using “Reverse Snowplow” Technique During Transcatheter Aortic Valve Replacement. Cardiol Cardiovasc Res. 2023;7(1):1-4. doi: 10.11648/j.ccr.20230701.11

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@article{10.11648/j.ccr.20230701.11,
  author = {Veronica Ricker and Hunter Row and Anyamaria Edwards and Johnathan Beaudrie and Cornelius Dyke and Thomas Haldis},
  title = {Endovascular Management of External Iliac “Snowplowing” Using “Reverse Snowplow” Technique During Transcatheter Aortic Valve Replacement},
  journal = {Cardiology and Cardiovascular Research},
  volume = {7},
  number = {1},
  pages = {1-4},
  doi = {10.11648/j.ccr.20230701.11},
  url = {https://doi.org/10.11648/j.ccr.20230701.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20230701.11},
  abstract = {This case describes an 84-year-old female with chronic diastolic heart failure, coronary artery disease status post coronary artery bypass and percutaneous coronary intervention, hypertension, diabetes mellitus and chronic kidney disease stage III, who presented with progressive dyspnea found to have severe aortic stenosis demonstrated by echocardiogram (aortic valve area, .06 cm2; mean gradient, 42 mm Hg). She was evaluated by the Heart Team and deemed to be a candidate for a transfemoral transcatheter aortic valve replacement (TAVR) after computed tomography angiography (CTA) evaluation. During insertion of the valve sheath through the external iliac, intimal “snowplowing” occurred resulting in complete occlusion of the iliac artery. The intima was successfully milked back into anatomical position using a “reverse snowplow” technique. Extravasation was managed with covered stents. The patient recovered over several days and was discharged home on post-procedure day 7. When appropriate, Endovascular management of vascular complications avoids the morbidity associated with open repair. Pre-operative evaluation is imperative in identifying anatomical features that pose a risk to vascular complications. This patient had an increased risk with an elevated iliofemoral tortuosity score, however, had minimal calcification and no acute angulation in the iliofemoral arterial system. This case highlights the complexity of vascular complication management and difficulty faced in identifying patients who are at risk for these types of complications.},
 year = {2023}
}

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TY  - JOUR
T1  - Endovascular Management of External Iliac “Snowplowing” Using “Reverse Snowplow” Technique During Transcatheter Aortic Valve Replacement
AU  - Veronica Ricker
AU  - Hunter Row
AU  - Anyamaria Edwards
AU  - Johnathan Beaudrie
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DO  - 10.11648/j.ccr.20230701.11
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
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AB  - This case describes an 84-year-old female with chronic diastolic heart failure, coronary artery disease status post coronary artery bypass and percutaneous coronary intervention, hypertension, diabetes mellitus and chronic kidney disease stage III, who presented with progressive dyspnea found to have severe aortic stenosis demonstrated by echocardiogram (aortic valve area, .06 cm2; mean gradient, 42 mm Hg). She was evaluated by the Heart Team and deemed to be a candidate for a transfemoral transcatheter aortic valve replacement (TAVR) after computed tomography angiography (CTA) evaluation. During insertion of the valve sheath through the external iliac, intimal “snowplowing” occurred resulting in complete occlusion of the iliac artery. The intima was successfully milked back into anatomical position using a “reverse snowplow” technique. Extravasation was managed with covered stents. The patient recovered over several days and was discharged home on post-procedure day 7. When appropriate, Endovascular management of vascular complications avoids the morbidity associated with open repair. Pre-operative evaluation is imperative in identifying anatomical features that pose a risk to vascular complications. This patient had an increased risk with an elevated iliofemoral tortuosity score, however, had minimal calcification and no acute angulation in the iliofemoral arterial system. This case highlights the complexity of vascular complication management and difficulty faced in identifying patients who are at risk for these types of complications.
VL  - 7
IS  - 1
ER  -

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Author Information

Veronica Ricker

Department of Surgery, University of North Dakota SMHS, Grand Forks, USA
Hunter Row

Department of Surgery, University of North Dakota SMHS, Grand Forks, USA
Anyamaria Edwards

Department of Surgery, University of North Dakota SMHS, Grand Forks, USA
Johnathan Beaudrie

Department of Surgery, University of North Dakota SMHS, Grand Forks, USA
Cornelius Dyke

Department of Cardiothoracic Surgery, Sanford Health, Fargo, USA
Thomas Haldis

Department of Cardiology, Sanford Health, Fargo, USA

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Plain Text BibTeX RIS

APA Style

Veronica Ricker, Hunter Row, Anyamaria Edwards, Johnathan Beaudrie, Cornelius Dyke, et al. (2023). Endovascular Management of External Iliac “Snowplowing” Using “Reverse Snowplow” Technique During Transcatheter Aortic Valve Replacement. Cardiology and Cardiovascular Research, 7(1), 1-4. https://doi.org/10.11648/j.ccr.20230701.11

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ACS Style

Veronica Ricker; Hunter Row; Anyamaria Edwards; Johnathan Beaudrie; Cornelius Dyke, et al. Endovascular Management of External Iliac “Snowplowing” Using “Reverse Snowplow” Technique During Transcatheter Aortic Valve Replacement. Cardiol. Cardiovasc. Res. 2023, 7(1), 1-4. doi: 10.11648/j.ccr.20230701.11

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AMA Style

Veronica Ricker, Hunter Row, Anyamaria Edwards, Johnathan Beaudrie, Cornelius Dyke, et al. Endovascular Management of External Iliac “Snowplowing” Using “Reverse Snowplow” Technique During Transcatheter Aortic Valve Replacement. Cardiol Cardiovasc Res. 2023;7(1):1-4. doi: 10.11648/j.ccr.20230701.11

Copy | Download

@article{10.11648/j.ccr.20230701.11,
  author = {Veronica Ricker and Hunter Row and Anyamaria Edwards and Johnathan Beaudrie and Cornelius Dyke and Thomas Haldis},
  title = {Endovascular Management of External Iliac “Snowplowing” Using “Reverse Snowplow” Technique During Transcatheter Aortic Valve Replacement},
  journal = {Cardiology and Cardiovascular Research},
  volume = {7},
  number = {1},
  pages = {1-4},
  doi = {10.11648/j.ccr.20230701.11},
  url = {https://doi.org/10.11648/j.ccr.20230701.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20230701.11},
  abstract = {This case describes an 84-year-old female with chronic diastolic heart failure, coronary artery disease status post coronary artery bypass and percutaneous coronary intervention, hypertension, diabetes mellitus and chronic kidney disease stage III, who presented with progressive dyspnea found to have severe aortic stenosis demonstrated by echocardiogram (aortic valve area, .06 cm2; mean gradient, 42 mm Hg). She was evaluated by the Heart Team and deemed to be a candidate for a transfemoral transcatheter aortic valve replacement (TAVR) after computed tomography angiography (CTA) evaluation. During insertion of the valve sheath through the external iliac, intimal “snowplowing” occurred resulting in complete occlusion of the iliac artery. The intima was successfully milked back into anatomical position using a “reverse snowplow” technique. Extravasation was managed with covered stents. The patient recovered over several days and was discharged home on post-procedure day 7. When appropriate, Endovascular management of vascular complications avoids the morbidity associated with open repair. Pre-operative evaluation is imperative in identifying anatomical features that pose a risk to vascular complications. This patient had an increased risk with an elevated iliofemoral tortuosity score, however, had minimal calcification and no acute angulation in the iliofemoral arterial system. This case highlights the complexity of vascular complication management and difficulty faced in identifying patients who are at risk for these types of complications.},
 year = {2023}
}

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TY  - JOUR
T1  - Endovascular Management of External Iliac “Snowplowing” Using “Reverse Snowplow” Technique During Transcatheter Aortic Valve Replacement
AU  - Veronica Ricker
AU  - Hunter Row
AU  - Anyamaria Edwards
AU  - Johnathan Beaudrie
AU  - Cornelius Dyke
AU  - Thomas Haldis
Y1  - 2023/01/17
PY  - 2023
N1  - https://doi.org/10.11648/j.ccr.20230701.11
DO  - 10.11648/j.ccr.20230701.11
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 1
EP  - 4
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20230701.11
AB  - This case describes an 84-year-old female with chronic diastolic heart failure, coronary artery disease status post coronary artery bypass and percutaneous coronary intervention, hypertension, diabetes mellitus and chronic kidney disease stage III, who presented with progressive dyspnea found to have severe aortic stenosis demonstrated by echocardiogram (aortic valve area, .06 cm2; mean gradient, 42 mm Hg). She was evaluated by the Heart Team and deemed to be a candidate for a transfemoral transcatheter aortic valve replacement (TAVR) after computed tomography angiography (CTA) evaluation. During insertion of the valve sheath through the external iliac, intimal “snowplowing” occurred resulting in complete occlusion of the iliac artery. The intima was successfully milked back into anatomical position using a “reverse snowplow” technique. Extravasation was managed with covered stents. The patient recovered over several days and was discharged home on post-procedure day 7. When appropriate, Endovascular management of vascular complications avoids the morbidity associated with open repair. Pre-operative evaluation is imperative in identifying anatomical features that pose a risk to vascular complications. This patient had an increased risk with an elevated iliofemoral tortuosity score, however, had minimal calcification and no acute angulation in the iliofemoral arterial system. This case highlights the complexity of vascular complication management and difficulty faced in identifying patients who are at risk for these types of complications.
VL  - 7
IS  - 1
ER  -

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