title: Vascular access site complications after percutaneous transfemoral aortic valve implantation.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) is a rapidly emerging treatment option for patients with aortic valve stenosis and high surgical risk. Different access routes have been proposed for TAVI including transapical, transsubclavian and transfemoral, with percutaneous transfemoral being the preferred because least invasive and nonsurgical. However, vascular access site complications due to the large-bore delivery catheters remain an important clinical issue, particularly with respect to the elderly patient collective typically considered for TAVI. In the study, the authors analyzed their 4-year TAVI experience with respect to vascular complications and their management in patients undergoing completely percutaneous transfemoral TAVI procedures.
  
  
  METHODS
  Since 2006, TAVI was performed in 101 consecutive patients at the West German Heart Center Essen. 33 patients underwent transapical TAVI, eight patients transfemoral TAVI with surgical access or closure, and 60 patients percutaneous transfemoral TAVI using two commercially available prosthetic valve devices.
  
  
  RESULTS
  Completely percutaneous TAVI was technically successful in all but one patient with malpositioning in the aortic arch during valve retrieval. There was no intraprocedural death and 30-day mortality was 12% (7/60). Vascular access site complications occurred in 19 patients (32%), necessitating surgical repair in six of them (10%). Complications included retroperitoneal hematoma (n = 2), iliac or femoral artery dissection (n = 10), (pseudo)aneurysm formation (n = 3), and closure device-induced vessel stenosis/ occlusion (n = 6). Of these, 13 cases could be managed either conservatively (n = 5) or by contralateral endovascular treatment (n = 8).
  
  
  CONCLUSIONS
  Completely percutaneous TAVI has a high acute success rate with low intraprocedural and 30-day mortality. The patient collective appears to be prone to vascular complications which remain an important limitation of this novel technique. Although conservative or endovascular management is possible in the majority of cases, further technological developments are obliged to reduce the vascular complication rate.
authors.affiliation: Department of Cardiology, West German Heart Center Essen, University Hospital Essen, University of Duisburg-Essen, Essen, Germany. Philipp.Kahlert@uk-essen.de
authors.forename: Philipp
authors.initials: P
authors.lastname: Kahlert
authors.forename: Fadi
authors.initials: F
authors.lastname: Al-Rashid
authors.forename: Marcel
authors.initials: M
authors.lastname: Weber
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendt
authors.forename: Torsten
authors.initials: T
authors.lastname: Heine
authors.forename: Eva
authors.initials: E
authors.lastname: Kottenberg
authors.forename: Matthias
authors.initials: M
authors.lastname: Thielmann
authors.forename: Hilmar
authors.initials: H
authors.lastname: Kühl
authors.forename: Jürgen
authors.initials: J
authors.lastname: Peters
authors.forename: Heinz G
authors.initials: HG
authors.lastname: Jakob
authors.forename: Stefan
authors.initials: S
authors.lastname: Sack
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.forename: Holger
authors.initials: H
authors.lastname: Eggebrecht
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D006328:Cardiac Catheterization / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D008297:Male; D010348:Patient Care Team; D015995:Prevalence; D016019:Survival Analysis; D015996:Survival Rate; D014652:Vascular Diseases / Q000401:mortality*