title: Management of vascular complications following transcatheter aortic valve implantation.
abstract: BACKGROUND
  Vascular complications (VCs) after transcatheter aortic valve implantation (TAVI) are frequent and their management is challenging.
  
  
  OBJECTIVE
  To report the incidence, predictors and management of VCs following percutaneous transfemoral TAVI (TF-TAVI) at a single centre.
  
  
  METHODS
  We analyzed 102 consecutive patients who underwent percutaneous TF-TAVI between August 2008 and December 2013. All endpoints were evaluated at 30 days and 6 months according to Valve Academic Research Consortium-2 criteria. VC percutaneous treatment success was defined as residual stenosis<30%, absence of blood extravasation and absence of surgical or repeat endovascular intervention at 30 days.
  
  
  RESULTS
  Twenty-two patients (22%) experienced VCs, including five patients (5%) with major VCs. Mortality at 30 days was significantly higher in patients with major VCs than in patients without major VCs (60% vs 3%; P=0.001). Patients with VCs had more life-threatening or major bleeding (23% vs 5%; P=0.02), but no difference in terms of need for blood transfusion was observed. Endovascular treatment was used in 13 of 22 patients with VCs (59%) and was successful in 11 of these 13 patients (85%). Primary surgical repair was necessary in only 1/22 (5%) patients, for a common femoral artery pseudoaneurysm 2 weeks after the TAVI procedure.
  
  
  CONCLUSIONS
  VCs following TF-TAVI are frequent. Major but not minor VCs are associated with increased mortality. Percutaneous management of VCs is feasible and safe, and surgery is rarely needed.
authors.affiliation: Cardiology Division, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland. Electronic address: nils.perrin@bluewin.ch.
authors.forename: Nils
authors.initials: N
authors.lastname: Perrin
authors.affiliation: Anaesthesiology Department, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Ellenberger
authors.affiliation: Anaesthesiology Department, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Licker
authors.affiliation: Radiology Department, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Anne-Lise
authors.initials: AL
authors.lastname: Hachulla
authors.affiliation: Cardiovascular Surgery Division, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Cikirikcioglu
authors.affiliation: Cardiology Division, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.
authors.forename: Angela
authors.initials: A
authors.lastname: Frei
authors.affiliation: Cardiology Division, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Roffi
authors.affiliation: Cardiology Division, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Noble
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D019233:Retreatment; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*
keywords: Complication vasculaire; Covered stent; Intervention vasculaire périphérique; Peripheral intervention; Remplacement valvulaire aortique percutané; Stent couvert; Transcatheter aortic valve implantation; Vascular complication