Renal Artery Perforation During Transcatheter Aortic Valve Replacement.

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is a well-established modality to treat severe aortic stenosis. CASE SUMMARY: We report a case of a woman in her 70s who underwent TAVR. The procedure was complicated owing to right renal artery perforation by a 0.038-inch angled-tip hydrophilic guidewire during closure of the left femoral artery, requiring implantation of a covered stent in renal artery to achieve hemostasis. DISCUSSION: In cases of shock during TAVR, injury to nonaccess site vessels should be considered. Treatment of iatrogenic renal artery injury with covered stent deployment achieves rapid hemostasis and preserves kidney function. TAKE-HOME MESSAGES: In case of periprocedural hemorrhagic shock during TAVR, injury to nonaccess site vessels should be considered. Meticulous fluoroscopic guidance should always be used when advancing guidewires to prevent vascular damage. Awareness of patient-specific anatomical variation of arteries can help the operator to be more cautious and avoid entering that artery.