A successful transfemoral transcatheter aortic valve replacement case with VIABAHN® VBX balloon‐expandable stent‐graft and long Dryseal sheath for challenging access route

KEY CLINICAL MESSAGE: A combination of long large‐bore sheath and balloon‐expandable stent‐graft can be effective to challenging access route in transfemoral transcatheter aortic valve replacement. ABSTRACT: An 88‐year‐old female with symptomatic severe aortic stenosis underwent transcatheter aortic valve replacement (TAVR). Multidetector computed tomography demonstrated a small aortic annulus, shaggy aorta, and significant stenosis with heavily calcified atherosclerotic lesions in the bilateral common iliac arteries (CIAs). TAVR with Evolut™ Pro+ via alternative approach was considered; however, our heart team concluded that the patient was unsuitable for the procedure due to anatomical reasons, patient frailty, and medication history. Finally, transfemoral TAVR with endovascular therapy (EVT) and 18Fr‐65 cm‐Dryseal was adopted for the site. Following EVT with VIABAHN® VBX balloon‐expandable stent‐graft (VBX) implantation to the right ostial CIA lesion, 18Fr‐65 cm‐Dryseal was advanced to the ascending aorta through VBX, and Evolut™ Pro+26 mm was successfully implanted without any complication. At the 2‐month follow‐up, the patient reported a significant improvement in shortness of breath and did not present any evidence of atheroembolism. Transfemoral TAVR with 18Fr‐65 cm‐Dryseal to shaggy aorta can be feasible depending on the plaque distribution, and VBX implantation to a heavily calcified ostial CIA lesion was safe and effective for obtaining enough lumen for a large‐bore sheath.