title: Use of an ePTFE-covered nitinol self-expanding stent graft for the treatment off pre-closure device failure during transcatheter aortic valve replacement.
abstract: OBJECTIVE
  Our aim was to describe our experience with the use of an ePTFE-covered nitinol self-expanding stent graft (GORE® VIABAHN® Endoprosthesis, Gore Medical, USA) placed in the common femoral artery for the treatment of suture-mediated pre-closure device failure following transcatheter aortic valve replacement (TAVR).
  
  
  BACKGROUND
  Access site-related vascular complications (VC) following sheath removal related to pre-closure device failure during TAVR are common and treatment options may vary.
  
  
  METHODS
  We performed an observational study on a series of consecutive patients who underwent TAVR between 2013 and 2015.
  
  
  RESULTS
  Included were 25 patients at a mean (±SD) age of 82±9. Failure of the closure device resulted in overt bleeding in 19 patients, dissection or no flow in 5 patients, and angiographic pseudoaneurysm in 1. Overall 29 stents were deployed with diameters ranging from 8 to 11mm and a length of 50mm (26, 90%). All stent-graft deployments achieved complete hemostasis of the arteriotomy site and resulted in normal flow to the distal vessels. None of the patients required open surgical repair. The mean hemoglobin drop was 2.6±1.3g/dl. Blood transfusions were used in 15 (60%) patients. Acute kidney injury occurred in 4 (16%) patients, none of whom was treated with dialysis. Length of hospital stay was 9±5days. All patients survived during a 30-day follow-up period, and none had VC related to the stented site.
  
  
  CONCLUSIONS
  The use of an ePTFE-covered Nitinol self-expanding stent graft is a feasible, safe, and effective treatment modality for access site-related VC following TAVR.
  
  
  CONCLUSIONS
  The use of an ePTFE-covered nitinol self-expanding stent graft placed in the common femoral artery for the treatment of suture-mediated pre-closure device failure following transcatheter aortic valve replacement (TAVR) is described in 25 patients. Its use was found to be feasible, safe, and an effective treatment modality for access site-related vascular complications following TAVR.
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Arie
authors.initials: A
authors.lastname: Steinvil
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Nelson
authors.initials: N
authors.lastname: Bernardo
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Toby
authors.initials: T
authors.lastname: Rogers
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Koifman
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Kyle
authors.initials: K
authors.lastname: Buchanan
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: M Chadi
authors.initials: MC
authors.lastname: Alraies
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Shults
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Petros G
authors.initials: PG
authors.lastname: Okubagzi
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Itsik
authors.initials: I
authors.lastname: Ben-Dor
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA. Electronic address: Ron.waksman@medstar.net.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys / Q000627:therapeutic use*; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D015607:Stents; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000497:Alloys; C013616:nitinol
keywords: Covered stent; Transcatheter aortic valve replacement; Vascular complications