title: Transfemoral access assessment for transcatheter aortic valve replacement: evidence-based application of computed tomography over invasive angiography.
abstract: BACKGROUND
  Although computed tomography (CT) is commonly used for iliofemoral evaluation for transfemoral transcatheter aortic valve replacement, many centers worldwide use invasive angiography alone for this purpose. No study to date has evaluated the value of CT over angiography for the prediction of vascular complications. In addition, no data exist for the value of noncontrast CT.
  
  
  RESULTS
  Of the 588 transcatheter aortic valve replacement patients, we reviewed 496 consecutive transfemoral cases. Vessel diameters were measured by CT or angiography. Sheath-related complication (SRC) was defined as an iliofemoral arterial injury not including a cannulation site. Receiver operating characteristic models were generated using sheath-to-iliofemoral artery ratios as a variable and SRC as an end point. In patients undergoing both contrast CT and angiography (n=283; 35 SRCs), contrast CT showed a greater predictive value than angiography by area under the curve P<0.001): 0.87 (95% confidence interval: 0.82-0.91) versus 0.72 (95% confidence interval: 0.66-0.77). In patients undergoing both noncontrast CT and angiography (n=103; 17 SRCs), there was no difference between noncontrast CT and angiography: 0.79 (95% confidence interval: 0.70-0.86) versus 0.73 (95% confidence interval: 0.63-0.81). Three-dimensional assessments of calcification and tortuosity provided limited additional value for SRC prediction.
  
  
  CONCLUSIONS
  Contrast CT has a greater predictive value for post-transcatheter aortic valve replacement vascular complications than angiography. Because these complications increase mortality, an accurate assessment of the vasculature is a critical component of proper access selection.
authors.affiliation: From the Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Okuyama
authors.affiliation: From the Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA.
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.affiliation: From the Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Kashif
authors.affiliation: From the Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Takahashi
authors.affiliation: From the Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA.
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.affiliation: From the Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA.
authors.forename: Heera
authors.initials: H
authors.lastname: Pokhrel
authors.affiliation: From the Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA.
authors.forename: Jigar
authors.initials: J
authors.lastname: Patel
authors.affiliation: From the Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA.
authors.forename: James S
authors.initials: JS
authors.lastname: Forrester
authors.affiliation: From the Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA.
authors.forename: Mamoo
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: From the Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA.
authors.forename: Wen
authors.initials: W
authors.lastname: Cheng
authors.affiliation: From the Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA. Raj.Makkar@cshs.org.
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000628:therapy*; D019540:Area Under Curve; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D003287:Contrast Media; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging* / Q000293:injuries; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D015141:Los Angeles; D008297:Male; D015999:Multivariate Analysis; D018579:Patient Selection; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000209:etiology
chemical_list: D003287:Contrast Media
keywords: angiography; cone-beam computed tomography; diabetic vascular complications