title: Vascular complications in steroid treated patients undergoing transfemoral aortic valve implantation.
abstract: OBJECTIVE
  To assess the rate of Vascular complications in steroid treated patients undergoing transfemoral aortic valve implantation (TAVI).
  
  
  BACKGROUND
  Steroid therapy has been associated with increased post-surgical bleeding. Vascular complications are a major concern in patients undergoing TAVI. However, the effect of corticosteroids on vascular complications has not been assessed in these patients.
  
  
  METHODS
  We conducted a retrospective analysis of 220 consecutive patients undergoing transfemoral TAVI at our institute between 2009 and 2013. Patients who were on steroids at the time of the procedure (n = 25) were compared with those who were not (n = 195).
  
  
  RESULTS
  Baseline characteristics between groups were similar except for greater incidence of chronic renal failure (52 vs. 25%, P = 0.05) and lower left ventricular ejection fraction (50.3 vs. 55.8%, P = 0.037) in the steroid group. The rate of procedural success and nonvascular complication were similar in both groups with the exception of more temporary AV block in the steroid group (24 vs. 8%, P = 0.016). Patients treated with steroids had significantly more minor vascular complication (44 vs. 23%, P = 0.024), and significantly more femoral artery stenosis (16 vs. 5%, P = 0.036), occlusion (8 vs. 1%, P = 0.014), need for femoral artery percutaneous transluminal angioplasty (PTA) (32 vs. 12%, P = 0.009), and femoral artery PTA or stenting (32% vs. 15%, P = 0.031). On multivariate analysis steroid treatment was the only predictor of minor vascular complications (RR=2.65, 95% CI 1.04-6.8, P = 0.042).
  
  
  CONCLUSIONS
  Concurrent corticosteroid treatment is associated with a higher rate of minor vascular complication following transfemoral TAVI. Operators should be aware of this risk when assessing patients for the procedure.
authors.forename: Noam
authors.initials: N
authors.lastname: Fink
authors.forename: Amit
authors.initials: A
authors.lastname: Segev
authors.forename: Israel
authors.initials: I
authors.lastname: Barbash
authors.forename: Andrada
authors.initials: A
authors.lastname: Bogdan
authors.forename: Ashraf
authors.initials: A
authors.lastname: Hamdan
authors.forename: Israel
authors.initials: I
authors.lastname: Mazin
authors.forename: Elad
authors.initials: E
authors.lastname: Maor
authors.forename: Ilan
authors.initials: I
authors.lastname: Hay
authors.forename: Victor
authors.initials: V
authors.lastname: Guetta
authors.affiliation: Leviev Heart Center, Interventional Cardiology division, Sheba Medical Center, Tel Hashomer, 52621, Israel.
authors.forename: Paul
authors.initials: P
authors.lastname: Fefer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D005263:Femoral Artery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013256:Steroids / Q000009:adverse effects*; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality
chemical_list: D013256:Steroids
keywords: aortic valve disease; complications; drug-drugs/pharmacotherapy; percutaneous intervention; percutaneous valve therapy; vascular access