2022 年 4 巻 1 号 p. 35-39
Objective: Trans-subclavian (TS)-transcatheter aortic valve replacement (TAVR) is a well-established alternative to transfemoral TAVR. In TS-TAVR, the axillary artery is commonly accessed through an infraclavicular incision. However, it is not rare that the axillary artery is too narrow or tortuous to access. The subclavian artery, which can be accessed through a supraclavicular incision, has a larger diameter and a lower tortuosity than the axillary artery. We report two cases of supraclavicular TS-TAVR and discuss the advantages and disadvantages of this approach.
Case Presentations: Both patients had symptomatic severe aortic stenosis and underwent supraclavicular TS-TAVR due to tortuous axillary arterial access. In case 1, we successfully performed TAVR using a self-expandable valve through the right subclavian artery. The patient’s postoperative course was unremarkable. The patient was discharged on postoperative day 6. In case 2, we performed TAVR using a self-expandable valve through the left subclavian artery. We encountered a vascular injury of the access route, which was unmanageable by surgical repair. We treated the injury site using endovascular repair with a stent graft. Postoperatively, the patient presented with muscle weakness in the left upper limb, which was suspected to be due to the intraoperative compression of the brachial plexus for hemostasis. The patient was discharged on postoperative day 16 and was fully recovered at the 3-month postoperative follow-up.
Conclusion: Supraclavicular TS-TAVR offers several advantages. If the surgeon is careful of the vessel and nerve injury, otherwise this can be one of the beneficial alternative approaches in cases where femoral and axillary arteries are not feasible.
