title: Complications of the access during aortic valve implantation through transfemoral access.
abstract: BACKGROUND
  Aortic valve implantation (AVI) is a booming therapeutic option in high-risk patients with calcific aortic stenosis. Retrograde femoral approach drawbacks include vascular complications owing to the size of the introduction system (22- and 24-F).The aim of this study was to retrospectively analyze the incidence and the treatment of vascular complications in the first 2 years of transfemoral AVI experience with the first generation of Edwards SAPIEN transcatheter heart valves.
  
  
  METHODS
  Since December 2007, AVI has been performed in 71 patients, 21 times by the transapical route and 50 times by the transfemoral route through an inguinal approach with the first generation of Edwards SAPIEN transcatheter heart valves (23 and 26 mm). The incidence and the treatment of vascular complications were evaluated as main criteria for transfemoral AVI.
  
  
  RESULTS
  All the procedures could be successfully performed by a femoral route, except for three cases when the introducing device could not be fixed on the thoracic aorta because of vascular access problems. Vascular access-related complications occurred in nine patients (18%), including three iliac dissections, two aortic dissections, three femoral lesions, and one thoracic aorta rupture. These complications were treated either in a conservative way (n = 2), or in an endovascular way using a contralateral approach (n = 3), or surgically through an inguinal approach (n = 3). A traumatic rupture of the thoracic aorta resulted in the death of a female patient.
  
  
  CONCLUSIONS
  In our experience, transfemoral AVI gives a satisfying technical success rate in the selected patients. The incidence of complications involving the vascular access remains an important limitation of this new technique. Although a conservative or endovascular treatment can be applied in most cases, improving the introduction devices is highly expected because it would reduce the complications rate of vascular access.
authors.affiliation: Service de Chirurgie Cardiaque et Vasculaire, Hôpital Européen Georges Pompidou, Université René Descartes, Paris, France. jean-marc.alsac@egp.aphp.fr
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Alsac
authors.forename: Rachid
authors.initials: R
authors.lastname: Zegdi
authors.forename: Didier
authors.initials: D
authors.lastname: Blanchard
authors.forename: Paul
authors.initials: P
authors.lastname: Achouh
authors.forename: Bernard
authors.initials: B
authors.lastname: Cholley
authors.forename: Alain
authors.initials: A
authors.lastname: Berrebi
authors.forename: Pierre
authors.initials: P
authors.lastname: Julia
authors.forename: Jean-Noël
authors.initials: JN
authors.lastname: Fabiani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D057510:Endovascular Procedures; D005260:Female; D005263:Femoral Artery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010297:Paris; D011474:Prosthesis Design; D011859:Radiography; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D014656:Vascular Surgical Procedures