Wong Chun-Ka, Chiu Alston Conrad Ho-On, Chan Kwong-Yue Eric, Sze Shu-Yue, Tam Frankie Chor-Cheung, Un Ka-Chun, Lam Simon Cheung-Chi, Tse Hung-Fat
Cardiology Division, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
Front Med Technol. 2022 Aug 18;4:959249. doi: 10.3389/fmedt.2022.959249. eCollection 2022.
Aortic stenosis (AS) is a prevalent disease affecting 3.7% of the adult population aged 65 or above. In the past, surgical aortic valve replacement (SAVR) was the only definitive therapy available for the treatment of severe AS. Owing to the invasive nature of open-heart surgery, patients with advanced age and frailty could not benefit from SAVR. The advent of transcatheter aortic valve replacement (TAVR) in the past decade has offered an alternative treatment option for patients with severe AS, particularly those who are deemed to have high surgical risks. Nevertheless, a large proportion of patients also have concomitant peripheral arterial disease (PAD), which increases the risk of peri-procedural vascular complication, and precludes the possibility of transfemoral TAVR owing to inadequate luminal size for delivery system deployment. In this review, the prevalence and outcome of TAVR patients with PAD will be discussed. Furthermore, novel technologies and techniques that enable TAVR to be safely performed using transfemoral or alternative access in patients with severe PAD will be reviewed.
主动脉瓣狭窄（AS）是一种常见疾病，影响着3.7%的65岁及以上成年人口。过去，外科主动脉瓣置换术（SAVR）是治疗重度AS的唯一确定性疗法。由于心脏直视手术具有侵入性，高龄和身体虚弱的患者无法从SAVR中获益。在过去十年中，经导管主动脉瓣置换术（TAVR）的出现为重度AS患者提供了另一种治疗选择，特别是那些被认为具有高手术风险的患者。然而，很大一部分患者还伴有外周动脉疾病（PAD），这增加了围手术期血管并发症的风险，并且由于输送系统部署的管腔尺寸不足而排除了经股动脉TAVR的可能性。在本综述中，将讨论伴有PAD的TAVR患者的患病率和结局。此外，还将综述能够使重度PAD患者通过经股动脉或其他入路安全进行TAVR的新技术和技术。
