title: Frequency and Effect of Access-Related Vascular Injury and Subsequent Vascular Intervention After Transcatheter Aortic Valve Replacement.
abstract: Vascular access and closure remain a challenge in transcatheter aortic valve replacement (TAVR). This single-center study aimed to report the incidence, predictive factors, and clinical outcomes of access-related vascular injury and subsequent vascular intervention. During a 30-month period, 365 patients underwent TAVR and 333 patients (94%) were treated by true percutaneous transfemoral approach. Of this latter group, 83 patients (25%) had an access-related vascular injury that was managed by the use of a covered self-expanding stent (n = 49), balloon angioplasty (n = 33), or by surgical intervention (n = 1). In 16 patients (5%), the vascular injury was classified as a major vascular complication. Absence of a preprocedural computed tomography angiography (CTA) of the iliofemoral arteries (OR 2.04, p = 0.007) and female gender (OR 2.18, p = 0.004) were independent predictors of the need for access-related vascular intervention. In addition, a high sheath/common femoral artery ratio as measured on preoperative CTA was associated with a higher rate of post-TAVR vascular intervention. The radiation dose, iodine contrast volume, transfusion need, length of hospitalization, and 30-day mortality were not significantly different between patients with versus without access-related vascular intervention. In conclusion, access-related vascular intervention in patients who underwent transfemoral-TAVR is not uncommon. Female gender and a high sheath/common femoral artery ratio are risk factors for access-related vascular injury, whereas preprocedural planning with CTA of the access vessels may reduce the risk of vascular injury. Importantly, most access-related vascular injuries may be treated by percutaneous techniques with similar clinical outcomes to patients without vascular injuries.
authors.affiliation: Department of Radiology, Rigshospitalet, Copenhagen, Denmark. Electronic address: dittedencker@gmail.com.
authors.forename: Ditte
authors.initials: D
authors.lastname: Dencker
authors.affiliation: Department of Radiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Mikkel
authors.initials: M
authors.lastname: Taudorf
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: N H Vincent
authors.initials: NH
authors.lastname: Luk
authors.affiliation: Department of Radiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Nielsen
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Klaus F
authors.initials: KF
authors.lastname: Kofoed
authors.affiliation: Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark.
authors.forename: Torben V
authors.initials: TV
authors.lastname: Schroeder
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Søndergaard
authors.affiliation: Department of Radiology, Rigshospitalet, Copenhagen, Denmark; Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Lönn
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: De Backer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000706:statistics & numerical data; D001024:Aortic Valve Stenosis / Q000601:surgery*; D000072226:Computed Tomography Angiography; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000293:injuries; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000293:injuries; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D012307:Risk Factors; D012421:Rupture / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D012737:Sex Factors; D015607:Stents / Q000706:statistics & numerical data; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy