title: Predicting vascular complications during transfemoral transcatheter aortic valve replacement using computed tomography: a novel area-based index.
abstract: BACKGROUND
  Computed tomography (CT) imaging has not been systematically studied for predicting vascular complications during transcatheter aortic valve replacement (TAVR).
  
  
  METHODS
  Clinical data were obtained from the electronic medical record and analysis was performed for each individual patient's iliofemoral CT angiogram. Sheath : femoral artery diameter ratio (SFAR) and sheath : femoral artery area ratio (SFAAR) were defined as the ratio of the sheath outer diameter to the femoral minimal lumen diameter (MLD) and sheath area to the femoral minimal lumen area (MLA), respectively.
  
  
  RESULTS
  A total of 255 patients underwent TF-TAVR with a 30-day mortality of 0.4% and 30-day stroke rate of 1.6%. Twenty-eight (11%) patients suffered a vascular complication, the majority of whom (82%) were managed percutaneously. Receiver operating characteristic (ROC) curve analysis demonstrated an SFAAR of 1.35 to predict the occurrence of vascular complications with a sensitivity of 78.6%. By comparison, similar analysis using SFAR provided a value of 1.45 with sensitivity of 64.2%. Multivariable modeling confirmed SFAR [OR (95% CI): 8.3(1.8-39.1)] and log-transformed SFAAR [OR (95% CI): 40.1 (2.4-650.0)] as significant predictors of vascular complication.
  
  
  CONCLUSIONS
  Using CT analysis, an SFAR of 1.45 and an SFAAR of 1.35 are each significant predictors of vascular complications among patients undergoing TF-TAVR. Utilization of CT-based area may provide a more accurate screen for patients undergoing evaluation for TF-TAVR as it takes into consideration the elliptical nature of the vessel. © 2014 Wiley Periodicals, Inc.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Amar
authors.initials: A
authors.lastname: Krishnaswamy
authors.forename: Akhil
authors.initials: A
authors.lastname: Parashar
authors.forename: Shikhar
authors.initials: S
authors.lastname: Agarwal
authors.forename: Dhruv K
authors.initials: DK
authors.lastname: Modi
authors.forename: Kanhaiya L
authors.initials: KL
authors.lastname: Poddar
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
authors.forename: Eric E
authors.initials: EE
authors.lastname: Roselli
authors.forename: Paul
authors.initials: P
authors.lastname: Schoenhagen
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods*; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome
keywords: aortic valve disease; complications; elderly patients; percutaneous intervention; transcatheter valve implantation; vascular access