title: Iliofemoral anatomy among Asians: implications for transcatheter aortic valve implantation.
abstract: OBJECTIVE
  This study aims to examine iliofemoral anatomy and predictors of vessel size and tortuosity in Asian patients as transfemoral transcatheter aortic valve implantation (TAVI) may be limited by the smaller Asian physique.
  
  
  METHODS
  Characteristics and vessel dimensions of 549 patients undergoing ultrasonography were reviewed. The minimal luminal diameter (MLD) along the iliofemoral vasculature of each side was identified and the larger of the two sides was used to determine suitability for transfemoral TAVI.
  
  
  RESULTS
  The mean age was 66 ± 11 years (68% males). Mean iliac MLD was 7.6 ± 1.7 mm, females smaller than males (7.2 ± 1.7 vs 7.8 ± 1.7, p<0.001). Mean iliac MLD decreased with age: 7.9 ± 1.7 mm, 7.4 ± 1.9 mm and 7.3 ± 1.6mm for ages <70 years, 70-79 years and ≥ 80 years respectively (p=0.038). Mean femoral MLD was 7.0 ± 1.7 mm, females smaller than males (6.3 ± 1.5mm vs 7.3 ± 1.8mm, p<0.001). Females were more likely than males to have iliac and femoral MLD <6mm (20% vs 12%, p=0.019 and 34% vs 21%, p=0.001). Independent predictors of smaller iliofemoral dimensions were female gender, lower body surface area, diabetes mellitus, dyslipidemia and smoking history. Significant iliac tortuosity was present in 11.8%, more frequent in males than females (15% vs 6%, p=0.005), and in those with logistic EuroSCORE ≥ 15 than <15 (27% vs 10%, p=0.001).
  
  
  CONCLUSIONS
  This study establishes the mean iliac and femoral artery diameters in a cohort of relatively young Asian patients. Age and female gender were associated with smaller vessel dimension and several independent predictors of smaller vasculature and tortuosity were identified. These results have implications for TF TAVI in Asia.
authors.affiliation: Department of Cardiology, National Heart Centre Singapore, Singapore. paul.chiam.t.l@nhcs.com.sg
authors.forename: Paul T L
authors.initials: PT
authors.lastname: Chiam
authors.forename: Angela S
authors.initials: AS
authors.lastname: Koh
authors.forename: See Hooi
authors.initials: SH
authors.lastname: Ewe
authors.forename: Yoong Kong
authors.initials: YK
authors.lastname: Sin
authors.forename: Victor T T
authors.initials: VT
authors.lastname: Chao
authors.forename: Choo Khong
authors.initials: CK
authors.lastname: Ng
authors.forename: Chung Yin
authors.initials: CY
authors.lastname: Lee
authors.forename: Yeong Phang
authors.initials: YP
authors.lastname: Lim
authors.forename: Jang Wen
authors.initials: JW
authors.lastname: Su
authors.forename: See Lim
authors.initials: SL
authors.lastname: Lim
authors.forename: Teing Ee
authors.initials: TE
authors.lastname: Tan
authors.forename: Chong Hee
authors.initials: CH
authors.lastname: Lim
authors.forename: Swee Yaw
authors.initials: SY
authors.lastname: Tan
authors.forename: Soo Teik
authors.initials: ST
authors.lastname: Lim
authors.forename: Terrance S J
authors.initials: TS
authors.lastname: Chua
authors.forename: Tian Hai
authors.initials: TH
authors.lastname: Koh
authors.forename: Yeow Leng
authors.initials: YL
authors.lastname: Chua
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005263:Femoral Artery / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007083:Iliac Artery / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*