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Cardiologia Croatica, Vol. 18 No. 11-12, 2023.

Meeting abstract

https://doi.org/10.15836/ccar2023.290

Clinical outcomes of percutaneous treatment of access site-related vascular injury after transfemoral transcatheter aortic valve implantation

Antonio Hanžek orcid id orcid.org/0000-0003-2308-3518 ; University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
Zvonimir Ostojić orcid id orcid.org/0000-0003-1762-9270 ; University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
Ivica Šafradin orcid id orcid.org/0000-0003-4519-5940 ; University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
Hrvoje Jurin ; University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
Tomislav Krčmar orcid id orcid.org/0000-0003-4689-1673 ; University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
Joško Bulum orcid id orcid.org/0000-0002-1482-6503 ; University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia

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Abstract

Keywords

transcatheter aortic valve implantation; access site-related vascular injury; stent-graft

Hrčak ID:

310192

URI

https://hrcak.srce.hr/310192

Publication date:

28.11.2023.

Visits: 360 *

Copyright statement: Croatian Cardiac Society

Copyright: 2023, Croatian Cardiac Society

Date received: 14 August 2023

Date accepted: 27 September 2023

Publication date (print and electronic): September 2023

Volume: 18

Issue: 11-12

Pages: 290-291

Publisher ID: CC 2023 18_11-12_290-1

DOI: 10.15836/ccar2023.290

Article Information (continued)

Categories:

Subject: Extended Abstract

Categories:

Subject: Valvular Heart Disease

KEYWORDS: :

KEYWORDS:

Keyword: transcatheter aortic valve implantation

Keyword: access site-related vascular injury

Keyword: stent-graft

Clinical outcomes of percutaneous treatment of access site-related vascular injury after transfemoral transcatheter aortic valve implantation

[https://orcid.org/0000-0003-2308-3518] Antonio Hanžek[1][*]

[https://orcid.org/0000-0003-1762-9270] Zvonimir Ostojić[1]

[https://orcid.org/0000-0003-4519-5940] Ivica Šafradin[1]

[https://orcid.org/0000-0002-2599-553X] Hrvoje Jurin[1]

[https://orcid.org/0000-0003-4689-1673] Tomislav Krčmar[1][2]

[https://orcid.org/0000-0002-1482-6503] Joško Bulum[1]

 

[1] University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia

[2] University of Rijeka, Faculty of Medicine, Rijeka, Croatia

Author notes:

Correspondence to: [*] ADDRESS FOR CORRESPONDENCE: Antonio Hanžek, Klinički bolnički centar Zagreb, Kišpatićeva 12, HR-10000 Zagreb, Croatia. / Phone: +385-1-2388-888 / E-mail: antoniohanzek0@gmail.com

Introduction: Percutaneous transfemoral transcatheter aortic valve implantation (pTF-TAVI) is an established method for the treatment of aortic stenosis in elderly patients. Despite improvements in this approach, access site-related vascular injury (ASRVI) remains a common complication (1). Although the implantation of a stent-graft (SG) in the common femoral artery (CFA) is not recommended, it is used to treat ASRVI despite the lack of clinical evidence (2). The aim is to evaluate the clinical outcomes in patients undergoing peripheral intervention for ASRVI related to pTF-TAVI.

Patients and Methods: This single-center retrospective analysis included all patients undergoing pTF-TAVI who experienced ASRVI treated with either balloon angioplasty or SG implantation in the CFA. Patient demographics, comorbidities, as well as procedural data during TAVI were collected. Patient clinical follow-up (FUP) data was collected during FUP interviews.

Results: A total of 197 patients underwent pTF-TAVI with MANTA as the primary vascular closure device. A total of 31 patients (15.7%) had ASRVI, the majority of whom (N=30, 96.7%) were successfully treated percutaneously and included in the study. The general patient and procedural characteristics are shown inTable 1. Of the 30 patients, 8 (26.6%) underwent balloon angioplasty and 22 (73.4%) underwent SG implantation. The mean FUP was 11 ± 6.3 months. The mean diameter of the balloon or SG used was 8.04 ± 1.13 mm. In the cases in which SG was implanted, most were balloon-expanding SG (N=19, 86.36). At FUP, 2 (6.67%) patients reported intermittent claudication, 6 (20%) had nonspecific limb pain, and the majority (N=23, 76.67%) had a walking distance of > 500 m. One patient initially treated with balloon angioplasty developed limiting claudication and underwent stent implantation. A comparison of clinical outcomes between patients treated with BD or SG is shown inTable 2.

TABLE 1 General and procedural characteristics of patients undergoing percutaneous treatment of access site-related vascular injury after transfemoral transcatheter aortic valve implantation.
N=30
Female - n (%)16 (53.33)
Age – mean ± SD81.38 ± 6.55
Coronary artery disease*, n (%)17 (56.67)
Atrial fibrillation, n (%)8 (26.67)
Chronic obstructive pulmonary disease, n (%)4 (13.33)
Chronic renal insufficiency**, n (%)13 (43.33)
Peripheral artery disease, n (%)
Occlusive PAD***, n (%)		17 (56.67)
8 (26.67)
Aortic valve replacement before TAVI, n (%)3 (10)
Mean left ventricular ejection fraction ± SD51.72 ± 12.41
Self-expanding valve, n (%)20 (66.6)
Mean valve size ± SD29.27 ± 6.23
*defined with coronary angiography; **defined as estimated glomerular filtration rate <60 ml/min/1.73 m2; ***Occlusive peripheral artery disease defined with CT angiography; SD standard deviation
TABLE 2 Comparison of clinical outcomes of patients treated with balloon angioplasty or stent-graft implantation.
Clinical outcomeGeneral (N=30)Balloon angioplasty (N=8)Stent-graft implantation (N=22)
Intermittent claudication, n (%)2 (6.66)1 (12.5)1 (4.54)
Non-specific limb pain, n (%)6 (20)0 (0)6 (27.27)
Additional vascular procedure*, n (%)1 (3.33)1 (12.5)0 (0)
Walking distance (m), n (%)
< 100
100 – 200
– 500
500 or more		1 (3.33)
2 (6.66)
3 (10)
23 (76.66)		1 (12.5)
0 (0)
0 (0)
7 (87.5)		0 (0)
2 (9.09)
3 (13.63)
16 (72.72)
Mortality**, n (%)4 (13.33)1 (12.5)3 (13.63)
CVI***, n (%)1 (3.33)1 (12.5)0 (0)
Permanent pacemaker implantation, n (%)****1 (3.33)0 (0)1 (4.54)
*Need for additional vascular intervention (percutaneous or surgery) during clinical follow-up, at the access site-related vascular injury site; **Mortality during clinical follow-up; ***Cerebrovascular insult during transcatheter aortic valve implantation procedure; ****Need for permanent pacemaker implantation after the transcatheter aortic valve implantation procedure.

Conclusion: The results of our single-center analysis demonstrate that peripheral vascular interventions, including implantation of SG in CFA, provide satisfactory 1-year clinical outcomes in elderly patients undergoing pTF-TAVI and thus can be considered as a bailout method for the treatment of ASRVI. Patients initially treated with SG did not need reintervention as they had no lifestyle-limiting claudication.

LITERATURE

1 

Toggweiler S, Leipsic J, Binder RK, Freeman M, Barbanti M, Heijmen RH, et al. Management of vascular access in transcatheter aortic valve replacement: part 2: Vascular complications. JACC Cardiovasc Interv. 2013 August;6(8):767–76. https://doi.org/10.1016/j.jcin.2013.05.004 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/23968697

2 

Sedaghat A, Hansen KL, Schahab N, May MC, Weber M, Stundl A, et al. Long-term follow-up after stent graft placement for access-site and access-related vascular injury during TAVI - The Bonn-Copenhagen experience. Int J Cardiol. 2019 April 15;281:42–6. https://doi.org/10.1016/j.ijcard.2018.12.053 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/30711261

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