Journal Article

Frequency and Effect of Access-Related Vascular Injury and Subsequent Vascular Intervention After Transcatheter Aortic Valve Replacement

Kofoed, Klaus F., Schroeder, Torben V., Taudorf, Mikkel, Nielsen, Michael B., De Backer, Ole, Søndergaard, Lars, Dencker, Ditte, Luk, N.H. Vincent, Lönn, Lars

2016

Overview

Vascular access and closure remain a challenge in transcatheter aortic valve replacement (TAVR). This single-center study aimed to report the incidence, predictive factors, and clinical outcomes of access-related vascular injury and subsequent vascular intervention. During a 30-month period, 365 patients underwent TAVR and 333 patients (94%) were treated by true percutaneous transfemoral approach. Of this latter group, 83 patients (25%) had an access-related vascular injury that was managed by the use of a covered self-expanding stent (n = 49), balloon angioplasty (n = 33), or by surgical intervention (n = 1). In 16 patients (5%), the vascular injury was classified as a major vascular complication. Absence of a preprocedural computed tomography angiography (CTA) of the iliofemoral arteries (OR 2.04, p = 0.007) and female gender (OR 2.18, p = 0.004) were independent predictors of the need for access-related vascular intervention. In addition, a high sheath/common femoral artery ratio as measured on preoperative CTA was associated with a higher rate of post-TAVR vascular intervention. The radiation dose, iodine contrast volume, transfusion need, length of hospitalization, and 30-day mortality were not significantly different between patients with versus without access-related vascular intervention. In conclusion, access-related vascular intervention in patients who underwent transfemoral-TAVR is not uncommon. Female gender and a high sheath/common femoral artery ratio are risk factors for access-related vascular injury, whereas preprocedural planning with CTA of the access vessels may reduce the risk of vascular injury. Importantly, most access-related vascular injuries may be treated by percutaneous techniques with similar clinical outcomes to patients without vascular injuries.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Aged / Aged, 80 and over / Angioplasty, Balloon - utilization / Aortic Valve Stenosis - surgery / Cardiovascular / Catheters / Computed Tomography Angiography / Female / Femoral Artery - diagnostic imaging / Femoral Artery - injuries / Hospitalization / Humans / Iliac Artery - diagnostic imaging / Iliac Artery - injuries / Male / Mortality / Postoperative Complications - epidemiology / Postoperative Complications - etiology / Postoperative Complications - therapy / Risk Factors / Rupture - epidemiology / Rupture - etiology / Rupture - therapy / Sex Factors / Stents / Stents - utilization / Transcatheter Aortic Valve Replacement - adverse effects / Treatment Outcome / Vascular System Injuries - epidemiology / Vascular System Injuries - etiology / Vascular System Injuries - therapy