# Renal Artery Perforation During Transcatheter Aortic Valve Replacement

## TL;DR

A rare case of renal artery perforation during TAVR is reported, highlighting the importance of careful guidewire use and awareness of anatomical variations.

## Contribution

The paper presents a novel clinical case emphasizing the risk of nonaccess site vascular injury during TAVR and its management with a covered stent.

## Key findings

- Renal artery perforation can occur during TAVR due to guidewire use.
- Covered stent deployment effectively achieves hemostasis and preserves kidney function.
- Awareness of anatomical variations can help prevent vascular injuries during the procedure.

## Abstract

Transcatheter aortic valve replacement (TAVR) is a well-established modality to treat severe aortic stenosis.

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.

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.

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.