title: Percutaneous management of vascular complications in patients undergoing transcatheter aortic valve implantation.
abstract: OBJECTIVE
  This study sought to investigate the feasibility and safety of percutaneous management of vascular complications after transcatheter aortic valve implantation (TAVI).
  
  
  BACKGROUND
  Vascular complications after TAVI are frequent and outcomes after percutaneous management of these adverse events not well established.
  
  
  METHODS
  Between August 2007 and July 2010, 149 patients underwent transfemoral TAVI using a percutaneous approach. We compared outcomes of patients undergoing percutaneous management of vascular complications with patients free from vascular complications and performed duplex ultrasonography, fluoroscopy, and multislice computed tomography during follow-up.
  
  
  RESULTS
  A total of 27 patients (18%) experienced vascular complications consisting of incomplete arteriotomy closure (n = 19, 70%), dissection (n = 3, 11%), arterial perforation (n = 3, 11%), arterial occlusion (n = 1, 4%), and pseudoaneurysm (n = 1, 4%). Percutaneous stent graft implantation was successful in 21 of 23 (91%) patients, whereas 2 patients were treated by manual compression, 2 patients underwent urgent surgery, and 2 patients required delayed surgery. Rates of major adverse cardiac events at 30 days were similar among patients undergoing percutaneous management of vascular complications and those without vascular complications (9% vs. 8%, p = 1.00). After a median follow-up of 10.9 months, imaging showed no evidence of hemodynamically significant stenosis (mean peak velocity ratio: 1.2 ± 0.4). Stent fractures were observed in 4 stents (22%, type I [6%], type II [16%]) and were clinically silent in all cases.
  
  
  CONCLUSIONS
  Vascular complications after TAVI can be treated percutaneously as a bailout procedure with a high rate of technical success, and clinical outcomes are comparable to patients without vascular complications. Stent patency is high during follow-up, although stent fractures require careful scrutiny.
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Stortecky
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland. Electronic address: peter.wenaweser@insel.ch.
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
authors.affiliation: Department of Clinical, Interventional Angiology, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Diehm
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pilgrim
authors.affiliation: Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Huber
authors.affiliation: Department of Diagnostic, Interventional, and Pediatric Radiology, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Andrea Bianca
authors.initials: AB
authors.lastname: Rosskopf
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Khattab
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland.
authors.forename: Lutz
authors.initials: L
authors.lastname: Buellesfeld
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland.
authors.forename: Steffen
authors.initials: S
authors.lastname: Gloekler
authors.affiliation: Department of Anesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Balthasar
authors.initials: B
authors.lastname: Eberle
authors.affiliation: Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland.
authors.forename: Jürg
authors.initials: J
authors.lastname: Schmidli
authors.affiliation: Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland.
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D006328:Cardiac Catheterization / Q000009:adverse effects*; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D016015:Logistic Models; D008297:Male; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011475:Prosthesis Failure; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014652:Vascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery / Q000628:therapy*