Abstract
Vascular access complications (VACs) remain one of the biggest challenges when performing transcatheter aortic valve implantation (TAVI). This study aimed to investigate the short- and medium-term safety and efficacy of the Viabahn endoprosthesis (Gore, Flagstaff, AZ) when used to treat TAVI-induced vascular injury. Over a 40-month period, 354 patients underwent true percutaneous transfemoral (TF)-TAVI using a CoreValve and Prostar-XL closure system; this was our study population. A VAC leading to acute intervention occurred in 72 patients (20.3%) - of these, 18 were managed by balloon angioplasty, 48 were treated by Viabahn stenting (technical success rate 98%), and 6 needed surgical intervention. Overall, this approach resulted in a major VAC rate of 3.1% (n = 11) in our study cohort. Length of hospitalization and 30-day mortality rates were comparable in patients with a VAC treated by Viabahn stenting versus patients without vascular complications. Two patients (4.5%) presented with new-onset claudication; one of them had the stent implanted covering the deep femoral artery (DFA). At medium-term follow-up (median 372 days; range 55 to 978 days) duplex ultrasound showed 100% patency of the Viabahn endoprostheses with no signs of stent fracture or in-stent stenosis/occlusion. In conclusion, the use of self-expanding covered stents is safe and effective in case of TF-TAVI-induced vascular injury, with good short- and medium-term outcomes. Importantly, coverage of the DFA should be avoided. If confirmed by long-term (>5 years) follow-up studies, this strategy for treating TAVI-induced VAC may be used routinely in high-risk patients.
Original language | English |
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Journal | American Journal of Cardiology |
Volume | 115 |
Issue number | 8 |
Pages (from-to) | 1123-9 |
Number of pages | 7 |
ISSN | 0002-9149 |
DOIs | |
Publication status | Published - 15 Apr 2015 |
Keywords
- Aged
- Aged, 80 and over
- Angiography
- Aortic Valve Stenosis
- Arterial Occlusive Diseases
- Blood Vessel Prosthesis
- Cardiac Catheterization
- Endovascular Procedures
- Female
- Femoral Artery
- Follow-Up Studies
- Humans
- Male
- Prosthesis Design
- Time Factors
- Tomography, X-Ray Computed
- Transcatheter Aortic Valve Replacement
- Treatment Outcome