title: Incidence and predictors of vascular access site complications following transfemoral transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Vascular access site complications in transfemoral (TF) transcatheter aortic valve implantation (TAVI) are associated with increased morbidity and mortality; however, their incidence and predictors are conflicting between studies. This study sought to assess the incidence and predictors of vascular access site complications in patients undergoing TF TAVI.
  
  
  METHODS
  A total of 140 patients undergoing TF TAVI were included in the study. Minimum iliofemoral diameter and iliofemoral calcium score (CS) were estimated from contrast-enhanced multidetector computed tomography imaging, using different thresholds according to aortic luminal attenuation. To assess the impact of the learning effect, the first 50% of TF TAVI procedures were compared to the remainder.
  
  
  RESULTS
  Fifty-one patients presented access site complications (7.1% major, 29.3% minor), most of which were local bleeding or hematoma (11.4%), pseudoaneurysm (7.9%) or closure device failure (5.0%). In a multivariate logistic regression analysis that included sheath-to-iliofemoral artery ratio (SIFAR) (the ratio between the sheath outer diameter and minimum iliofemoral diameter), iliofemoral CS and center experience, SIFAR was the sole independent predictor of access site complications (hazard ratio 14.5, confidence interval [CI] 95% 1.75-120.12, p=0.013). The SIFAR threshold with the highest sum of sensitivity (71.4%) and specificity (53.4%) for access site complications was 0.92 (area under the curve 0.66, 95% CI 0.56-0.75, p=0.002).
  
  
  CONCLUSIONS
  Vascular access site complications are frequent in patients undergoing TF TAVI. SIFAR was the only independent predictor of access site complications and therefore should be systematically assessed during pre-procedural imaging study.
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal. Electronic address: paulobarbosafonseca@hotmail.com.
authors.forename: Paulo
authors.initials: P
authors.lastname: Fonseca
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Almeida
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Bettencourt
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Ferreira
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
authors.forename: Mónica
authors.initials: M
authors.lastname: Carvalho
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
authors.forename: Wilson
authors.initials: W
authors.lastname: Ferreira
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
authors.forename: Daniel
authors.initials: D
authors.lastname: Caeiro
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
authors.forename: Helena
authors.initials: H
authors.lastname: Gonçalves
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Ribeiro
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
authors.forename: Alberto
authors.initials: A
authors.lastname: Rodrigues
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Braga
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
authors.forename: Vasco
authors.initials: V
authors.lastname: Gama
mesh_terms: D000368:Aged; D005260:Female; D005263:Femoral Artery; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*
keywords: Acesso iliofemoral; Complicações do acesso vascular; Iliofemoral access; Implantação de válvula aórtica por via percutânea; Transcatheter aortic valve implantation; Vascular access site complications