Safety and efficacy of using the Viabahn endoprosthesis for percutaneous treatment of vascular access complications after transfemoral aortic valve implantation

Ole De Backer, Samer Arnous, Benjamin Sandholt, Matthew Brooks, Luigi Biasco, Olaf Franzen, Lars Lönn, Bo Bech, Lars Søndergaard

23 Citations (Scopus)

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 languageEnglish
JournalAmerican Journal of Cardiology
Volume115
Issue number8
Pages (from-to)1123-9
Number of pages7
ISSN0002-9149
DOIs
Publication statusPublished - 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

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