Endovascular management of heavily calcified abdominal aorta dissection during transcatheter aortic valve implantation.

Figure 1. A. Before transcatheter aortic valve implantation (TAVI): abdominal aorta with extensive circumferential calcifications; B, C. After TAVI: fracture and vertical displacement of abdominal aorta wall with bilateral dissection traces; D, E. Transfemoral implantation of a covered metal stent across the fracture site and successful restoration of the aortic trajectory, without signs of residual dissection; F. Post-procedural computed tomography showing TAV-in-TAV implantation, transjugular temporary pacemaker lead and stent into the abdominal aorta. (TAVI). The first aortic prosthesis (Corevalve 29 mm, Medtronic, MN, USA) was implanted too high above the native aortic annulus, resulting in severe paravalvular regurgitation. TAV-in-TAV