Feasibility and outcomes of interventional treatment for vascular access site complications following transfemoral aortic valve implantation.
BACKGROUND
Despite the completion of more than 60,000 transcutaneous aortic valve implantations (TAVI) per year and an approximately 10-15 % incidence of vascular access site complications (VAC), there is a paucity of data on the efficacy and safety of percutaneous VAC treatment.


OBJECTIVE
Percutaneous endovascular treatment will be an effective treatment of VAC and associated with a low rate of surgical repair. Despite stent placement in proximity to the hip joint, endovascular treatment will be only rarely associated with disabling symptoms or complications.


METHODS
We conducted a retrospective database analysis including 355 patients who underwent TAVI from January 2011 to October 2015. To facilitate the detection of secondary complications of interventional VAC repair, we conducted structured telephone interviews with a focus on new diagnoses or symptoms of peripheral artery disease.


RESULTS
Only four patients (1.1 %) required surgical treatment for VAC. Percutaneous balloon angioplasty (PTA) or stent implantation was required for VAC in 44 patients (12.4 %). The technical success rate of percutaneous VAC treatment was 93 %. Four patients died within 30 days of VAC treatment, but only one fatality was directly attributable to VAC. Post procedure mean hospital stay was numerically prolonged by 2.4 days in the VAC treatment group (P = 0.06). During a median follow-up of 385 days (range 89-909 days) none of the patients were diagnosed with a late VAC or reported a new diagnosis or symptoms of perfusion deficit or peripheral artery disease.


CONCLUSIONS
Percutaneous treatment of VAC during TAVI is safe and effectively helps to minimize the need for surgery in the vast majority of VAC. During short- and mid-term follow-up, percutaneous VAC management is associated with low complication rates and good clinical outcomes.
Department of Cardiology and Pulmonology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany. tim.seidler@med.uni-goettingen.de.
Tim
T
Seidler
Department of Cardiology and Pulmonology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
Mark
M
Hünlich
Department of Cardiology and Pulmonology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
Miriam
M
Puls
Department of Cardiology and Pulmonology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
Gerd
G
Hasenfuß
Department of Cardiology and Pulmonology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
Claudius
C
Jacobshagen
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome; D062666:Vascular Access Devices / Q000009:adverse effects*
Peripheral vascular intervention; Self-expanding vascular stent; Transcatheter aortic valve implantation; Vascular access site complications
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