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Zeng H, Xie JY, Xu LX, Cao WY, Liu MJ, Que SW. Comparative study of the clinical value of digital subtraction angiography via femoral and radial arterial paths. Am J Transl Res 2024; 16:3064-3071. [PMID: 39114697 PMCID: PMC11301496 DOI: 10.62347/ubev9768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/07/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To evaluate the clinical efficacy of digital subtraction angiography (DSA) performed via femoral artery and radial artery approaches. METHODS This retrospective study included 480 patients requiring cerebral vascular angiography at the First People's Hospital of Changde City from March 2020 to February 2022. Patients were divided into the femoral artery group (transfemoral approach, n=400) and the radial artery group (transradial approach, n=80) according to the surgical route. We compared perioperative metrics, success rates of selective angiography and puncture, and complication rates (including pseudoaneurysm, urinary retention, hematoma, vasospasm) between the groups. Multivariate logistic regression was used to analyze factors influencing the failure of angiography by each approach. RESULTS The radial artery group exhibited shorter durations for puncture, hemostasis, exposure, operation, and postoperative recovery (all P<0.001). The success rate of selective angiography was higher in the radial artery group (93.75%) compared to the femoral artery group (85.25%) (χ2=4.168, P=0.041). No significant difference was found in puncture success rates between the groups (χ2=0.235, P=0.628). The overall complication rate was significantly lower in the radial artery group (2.50%) compared to the femoral artery group (9.25%) (χ2=4.069, P=0.044). Gender and low-density lipoprotein cholesterol levels were significant predictors of angiography failure in both approaches (both P<0.05). CONCLUSION The transradial approach for DSA is safe and feasible, offering advantages in terms of operational time and complication rates, making it the preferred method in clinical settings.
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Affiliation(s)
- Hu Zeng
- Neurosurgery Department, Changde Hospital, Xiangya School of Medicine, Central South UniversityChangde 415000, Hunan, China
| | - Jia-Yu Xie
- Neurosurgery Department, Changde Hospital, Xiangya School of Medicine, Central South UniversityChangde 415000, Hunan, China
| | - Li-Xin Xu
- Neurosurgery Department, Changde Hospital, Xiangya School of Medicine, Central South UniversityChangde 415000, Hunan, China
| | - Wu-Yang Cao
- Neurosurgery Department, Changde Hospital, Xiangya School of Medicine, Central South UniversityChangde 415000, Hunan, China
| | - Meng-Jiao Liu
- Gu Lian Rehabilitation Hospital of Changde CityChangde 415000, Hunan, China
| | - Si-Wei Que
- Neurosurgery Department, Changde Hospital, Xiangya School of Medicine, Central South UniversityChangde 415000, Hunan, China
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2
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Andréka J, Sasi V, Tóth GG, Ruzsa Z. Stent graft implantation from distal radial access-A novel way to treat femoral access site complication during transcatheter aortic valve replacement: A case report. Catheter Cardiovasc Interv 2024; 103:803-807. [PMID: 38415818 DOI: 10.1002/ccd.31001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/24/2023] [Accepted: 02/19/2024] [Indexed: 02/29/2024]
Abstract
In this paper, a case of an 82-year-old man who was admitted to our department with sever symptomatic degenerative aortic valve stenosis is presented and discussed. After all screening procedures, a successful transfemoral transcatheter aortic valve replacement was performed, but the closure of the femoral access was unsuccessful due to suture-based device failure. We decided to perform a prolonged balloon dilatation and external compression at the bleeding site, but the bleeding did not stop; therefore, an iCover stent graft was implanted from distal radial artery access using slender technique. Following that, the bleeding was stopped, and the patient had an uneventful outcome.
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Affiliation(s)
- Judit Andréka
- Internal Medicine Department, University of Szeged, Szeged, Hungary
- Department of Cardiology, Medical University Graz, Graz, Austria
| | - Viktor Sasi
- Internal Medicine Department, University of Szeged, Szeged, Hungary
| | - Gábor G Tóth
- Department of Cardiology, Medical University Graz, Graz, Austria
| | - Zoltán Ruzsa
- Internal Medicine Department, University of Szeged, Szeged, Hungary
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3
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Naoum I, Eitan A, Galili O, Hayeq H, Shiran A, Zissman K, Sliman H, Jaffe R. Strategy for Totally Percutaneous Management of Vascular Injury in Combined Transfemoral Transcatheter Aortic Valve Replacement and Endovascular Aortic Aneurysm Repair Procedures. Am J Cardiol 2023; 207:130-136. [PMID: 37738782 DOI: 10.1016/j.amjcard.2023.08.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/24/2023]
Abstract
Minimally invasive treatment of severe aortic stenosis by transcatheter aortic valve replacement (TAVR) and infrarenal abdominal aortic aneurysm by endovascular aortic aneurysm repair (EVAR) requires large-bore vascular access. These percutaneous transfemoral interventions may be performed as a combined procedure, however, vascular injury may necessitate surgical vascular repair. We implemented a strategy designed to enable percutaneous vascular repair, with stent-graft implantation, if necessary, after these combined procedures. We identified all combined percutaneous TAVR and EVAR procedures which were performed at our institution. Patient and procedural characteristics and clinical outcomes were analyzed. Six consecutive patients underwent total percutaneous combined TAVR and EVAR procedures. In all cases, TAVR was performed first and was followed by EVAR. Both common femoral arteries served as primary access sites for delivery of the implanted devices and hemostasis was achieved by deployment of vascular closure devices. Secondary access sites included the right brachial artery in all patients and superficial femoral arteries in 50% of the patients. In all cases an "0.014" 300-cm length "safety" wire was delivered to the common femoral artery or descending aorta by way of a secondary access site to facilitate stent graft delivery. Successful device implantation was achieved in all cases. Vascular closure device failure occurred in 2 patients and was treated by stent graft implantation by way of the brachial and superficial femoral arteries, without need for surgical vascular repair. A strategy designed to facilitate percutaneous vascular repair after combined EVAR and TAVR procedures may enable a truly minimally invasive procedure.
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Affiliation(s)
| | | | - Offer Galili
- Department of Vascular & Endovascular Surgery, Carmel Medical Center, Haifa, Israel
| | - Hashem Hayeq
- Department of Vascular & Endovascular Surgery, Carmel Medical Center, Haifa, Israel
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4
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Meertens M, Wegner M, Fischnaler C, Wienemann H, Macherey S, Lee S, Kuhn E, Mauri V, Dorweiler B, Baldus S, Adam M, Ahmad W. Surgical Versus Interventional Treatment of Major Access Site Complications During Transfemoral TAVI Procedures at a Large Volume Center. J Endovasc Ther 2023:15266028231204291. [PMID: 37853703 DOI: 10.1177/15266028231204291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
PURPOSE Access-related vascular complications in transfemoral transcatheter aortic valve implantation (TAVI) can be treated endovascularly or surgically. The aim of this study was to evaluate the short- and long-term outcomes of endovascular treatment compared with surgical repair for access-related vascular complications. METHODS This retrospective study was performed from January 1, 2018, to December 31, 2020. All transfemorally treated TAVI patients in whom a surgical or endovascular treatment for an access site complication was needed were included. The primary outcome was the need for any related vascular re-operation. RESULTS In total, 1219 transfemoral TAVI procedures were conducted during the study period. 19 patients suffered an access complication requiring endovascular treatment, while 54 patients required surgical repair. No differences were seen with regard to re-operations (endovascular 15.8% vs surgical 14.8%; p=0.919), wound infections (endovascular 0% vs surgical. 11.1%; p=0.129), and wound healing disorders (endovascular 15.8% vs surgical 29.6%; p=0.237). Patients undergoing endovascular treatment were discharged earlier (endovascular 11.2 vs surgical 14.9 days; p=0.028). After surgical repair, patients received significantly more blood transfusions than endovascularly treated patients (endovascular 1.00 vs surgical 3.1 red blood cell concentrate bags; p<0.001). No differences were found regarding the new onset of walking pain, rest pain, and ischemic ulcers during follow-up. CONCLUSION In this retrospective cohort, endovascular treatment of access-related vascular complications of transfemoral TAVI procedures was safe and feasible. During the hospital stay, endovascularly treated patients received fewer blood transfusions and were discharged faster than surgically treated patients. No differences regarding clinical outcomes and re-intervention rates were seen during the follow-up. CLINICAL IMPACT Given the in this retrospective study demonstrated safety and feasibility of endovascular treatment for major access-related vascular complications, along with the in-hospital benefits and absence of follow-up disadvantages compared to surgical treatment, endovascular treatment should be considered in cases of major access-related vascular complications in transfemoral TAVI patients.
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Affiliation(s)
- Max Meertens
- Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Moritz Wegner
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - Carlos Fischnaler
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - Hendrik Wienemann
- Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Sascha Macherey
- Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Samuel Lee
- Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Elmar Kuhn
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Victor Mauri
- Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Bernhard Dorweiler
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Matti Adam
- Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Wael Ahmad
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
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5
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Al-Kassou B, Al-Shaikh H, Aksoy A, Shamekhi J, Zietzer A, Sugiura A, Veulemans V, Adam M, Grube E, Bakhtiary F, Zimmer S, Kelm M, Baldus S, Nickenig G, Sedaghat A. Impact of transradial versus transfemoral access for preprocedural coronary angiography on TAVR-associated complications. IJC HEART & VASCULATURE 2023; 46:101205. [PMID: 37122629 PMCID: PMC10130599 DOI: 10.1016/j.ijcha.2023.101205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 05/02/2023]
Abstract
Background Vascular injury and bleeding complications remain frequent after transcatheter aortic valve replacement (TAVR). Whether the access-site of preprocedural coronary angiography (CAG) affects TAVR-related complications is not known. The aim of this study was to evaluate the impact of transradial (TRA) versus transfemoral access (TFA) for preprocedural CAG on outcomes in patients undergoing subsequent TAVR. Methods The study cohort included 1002 patients undergoing transfemoral TAVR, of whom 39.4% (395/1002) had undergone radial and 60.6% (607/1002) femoral access for pre-TAVR CAG. The primary endpoint was a composite of 30-day mortality and major vascular complications after TAVR. Key secondary endpoints included VARC-3-defined complications. Results The primary endpoint occurred less frequently in patients with prior TRA (3.3%) as compared to patients with prior TFA (6.3%, p = 0.04), which was mainly driven by significantly lower rates of major vascular complications (0.8% vs 2.5%, p = 0.05). Moreover, incidences of periprocedural access-related vascular injury and unplanned endovascular interventions were lower in TRA patients (13.2% vs 18.0%, p = 0.05). The rate of major bleeding tended to be lower in the TRA (1.5%) as compared to the TFA group (3.5%) but was not significantly different (p = 0.07). Moreover, the rate of life-threatening bleeding was comparable between both groups (0.5% vs 0.8%, p = 0.71). Conclusion Transradial access for preprocedural CAG was associated with significantly lower rates of vascular complications following subsequent TAVR as compared to transfemoral access. However, despite the tendency to lower major bleedings with transradial access, no significant association was detectable between the access-site of coronary angiography and TAVR-related bleeding complications.
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Affiliation(s)
- Baravan Al-Kassou
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Hasanin Al-Shaikh
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Adem Aksoy
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jasmin Shamekhi
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Andreas Zietzer
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Atsushi Sugiura
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Verena Veulemans
- Division of Cardiology, University Hospital of Duesseldorf, Germany
- CARID, Cardiovascular Research Institute Duesseldorf, Germany
| | - Matti Adam
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Eberhard Grube
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Farhad Bakhtiary
- Heart Center, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Malte Kelm
- CARID, Cardiovascular Research Institute Duesseldorf, Germany
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Georg Nickenig
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Alexander Sedaghat
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
- RheinAhrCardio, Praxis für Kardiologie, Bad Neuenahr-Ahrweiler, Germany
- Corresponding author.
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6
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Kalogeropoulos AS, Redwood SR, Allen CJ, Hurrell H, Chehab O, Rajani R, Prendergast B, Patterson T. A 20-year journey in transcatheter aortic valve implantation: Evolution to current eminence. Front Cardiovasc Med 2022; 9:971762. [PMID: 36479570 PMCID: PMC9719928 DOI: 10.3389/fcvm.2022.971762] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/31/2022] [Indexed: 07/26/2023] Open
Abstract
Since the first groundbreaking procedure in 2002, transcatheter aortic valve implantation (TAVI) has revolutionized the management of aortic stenosis (AS). Through striking developments in pertinent equipment and techniques, TAVI has now become the leading therapeutic strategy for aortic valve replacement in patients with severe symptomatic AS. The procedure streamlining from routine use of conscious sedation to a single arterial access approach, the newly adapted implantation techniques, and the introduction of novel technologies such as intravascular lithotripsy and the refinement of valve-bioprosthesis devices along with the accumulating experience have resulted in a dramatic reduction of complications and have improved associated outcomes that are now considered comparable or even superior to surgical aortic valve replacement (SAVR). These advances have opened the road to the use of TAVI in younger and lower-risk patients and up-to-date data from landmark studies have now established the outstanding efficacy and safety of TAVI in patients with low-surgical risk impelling the most recent ESC guidelines to propose TAVI, as the main therapeutic strategy for patients with AS aged 75 years or older. In this article, we aim to summarize the most recent advances and the current clinical aspects involving the use of TAVI, and we also attempt to highlight impending concerns that need to be further addressed.
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Affiliation(s)
- Andreas S. Kalogeropoulos
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Cardiology, MITERA General Hospital, Hygeia Healthcare Group, Athens, Greece
| | - Simon R. Redwood
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Christopher J. Allen
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Harriet Hurrell
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Omar Chehab
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Ronak Rajani
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Bernard Prendergast
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Tiffany Patterson
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
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7
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Maurina M, Condello F, Mangieri A, Sanz‐Sanchez J, Stefanini GG, Bongiovanni D, Cozzi O, Leone PP, Baggio S, Gasparini G, Pagnotta P, Civilini E, Colombo A, Reimers B, Regazzoli D. Long term follow-up after balloon expandable covered stents implantation for management of transcatheter aortic valve replacement related vascular access complications. Catheter Cardiovasc Interv 2022; 100:903-909. [PMID: 36040688 PMCID: PMC9804753 DOI: 10.1002/ccd.30385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 07/18/2022] [Accepted: 08/12/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To report the experience of a high-volume center with balloon-expandable (BE) stents implantation to manage vascular complications after transcatheter aortic valve replacement (TAVR). BACKGROUND Despite increased operator experience and better devices, vascular complications after TAVR are still a major issue and covered stent implantation is often required. METHODS We retrospectively collected baseline and procedural data about 78 consecutive patients who underwent BE stent implantation to manage a vascular complication after transfemoral TAVR. Primary endpoints were technical success, incidence of new-onset claudication and need for vascular interventions during long-term follow-up. Secondary endpoints included length of hospitalization, in-hospital and 30-day mortality, and major postoperative complications. RESULTS BE stents implantation to manage vascular complications after TAVR was successfully performed in 96.2% of the cases, with bailout surgery required in two cases. One patient suffered in-hospital death. Predischarge Doppler Ultrasound revealed no cases of in-stent occlusion or fracture. At a median follow-up of 429 days (interquartile range, 89-994 days), no cases of symptomatic leg ischemia were reported and only one patient experienced new-onset claudication. CONCLUSIONS Our experience showed good periprocedural and long-term results of BE covered stent implantation to manage vascular complication after TAVR. Their great radial outward force may guarantee effective hemostasis without necessarily being associated with stent deformation/fracture resulting in restenosis or further interventions. More research is needed to define the role of BE covered stents in this setting.
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Affiliation(s)
- Matteo Maurina
- IRCCS Humanitas Research HospitalMilanItaly,Department of Biomedical SciencesHumanitas UniversityMilanItaly
| | - Francesco Condello
- IRCCS Humanitas Research HospitalMilanItaly,Department of Biomedical SciencesHumanitas UniversityMilanItaly
| | | | - Jorge Sanz‐Sanchez
- IRCCS Humanitas Research HospitalMilanItaly,Hospital Universitari i Politecnic La Fe, CardiologyValenciaSpain,Centro de Investicación Biomedica en Red Enfermedades Cardiovasculares (CIBERCV)MadridSpain
| | - Giulio Giuseppe Stefanini
- IRCCS Humanitas Research HospitalMilanItaly,Department of Biomedical SciencesHumanitas UniversityMilanItaly
| | - Dario Bongiovanni
- IRCCS Humanitas Research HospitalMilanItaly,Department of Internal Medicine I, University Hospital rechts der IsarTechnical University of MunichMunichGermany
| | - Ottavia Cozzi
- IRCCS Humanitas Research HospitalMilanItaly,Department of Biomedical SciencesHumanitas UniversityMilanItaly
| | - Pier Pasquale Leone
- IRCCS Humanitas Research HospitalMilanItaly,Department of Biomedical SciencesHumanitas UniversityMilanItaly
| | - Sara Baggio
- IRCCS Humanitas Research HospitalMilanItaly,Department of Biomedical SciencesHumanitas UniversityMilanItaly
| | | | | | - Efrem Civilini
- Vascular SurgeryHumanitas Research Hospital IRCCSMilanItaly
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8
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Eitan A, Sliman H, Shiran A, Jaffe R. Strategies for Facilitating Totally Percutaneous Transfemoral TAVR Procedures. J Clin Med 2022; 11:jcm11082104. [PMID: 35456197 PMCID: PMC9028438 DOI: 10.3390/jcm11082104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 02/01/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has transformed the treatment of aortic stenosis and should ideally be performed as a totally percutaneous procedure via the transfemoral (TF) approach. Peripheral vascular disease may impede valve delivery, and vascular access site complications are associated with adverse clinical outcome and increased mortality. We review strategies aimed to facilitate TF valve delivery in patients with hostile vascular anatomy and achieve percutaneous management of vascular complications.
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9
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Lindner JU, Markuske M, Szczanowicz L, Jobs A, Abdel-Wahab M, Desch S, Thiele H, Sulimov DS. Balloon-assisted injection of fibrin sealant for the treatment of postintervention access-site bleeding complications. Catheter Cardiovasc Interv 2022; 99:1327-1334. [PMID: 35019201 DOI: 10.1002/ccd.30068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/25/2021] [Indexed: 12/24/2022]
Abstract
This study sought to evaluate a new method that uses injection of fibrin sealant under simultaneous balloon occlusion for the treatment of postinterventional access site bleeding complications. With the rising complexity of interventional procedures, iatrogenic false aneurysms and active bleeding has become more common. In general, these complications are associated with increased morbidity and mortality, especially if surgical repair is required. Although high success rates are reported for ultrasound-guided compression and ultrasound-guided thrombin injection, these methods are not always feasible. All procedures of fibrin sealant injection under simultaneous balloon occlusion for the treatment of postinterventional access site bleeding complications or pseudoaneurysm were prospectively collected. Additional data were retrospectively obtained and analyzed for all patients treated by this new method. In total, 53 patients were included from 2018 to 2021. Most of the access site complications were related to transcatheter aortic valve replacement (40%) or percutaneous coronary intervention (21%), but also to a wide variety of other procedures. Of the 53 patients, 30 had to be treated for false aneurysms and 23 for active bleeding. A high primary success rate of 94% was achieved. Recurrences of false aneurysms occurred in six patients, of which only one needed open surgical repair. Regarding complications, two peripheral embolisms, thereof one requiring additional stent implantation occurred. Balloon-assisted thrombin injection seems to be feasible and safe. It provides a new alternative to prevent surgery for patients where common techniques are unavailable or have failed.
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Affiliation(s)
- Jakob U Lindner
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Matthias Markuske
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Lukasz Szczanowicz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Alexander Jobs
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Mohamed Abdel-Wahab
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Steffen Desch
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Dmitry S Sulimov
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
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10
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Perrin N, Bonnet G, Leroux L, Ibrahim R, Modine T, Ben Ali W. Transcatheter Aortic Valve Implantation: All Transfemoral? Update on Peripheral Vascular Access and Closure. Front Cardiovasc Med 2021; 8:747583. [PMID: 34660747 PMCID: PMC8511676 DOI: 10.3389/fcvm.2021.747583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/30/2021] [Indexed: 12/19/2022] Open
Abstract
Transfemoral access remains the most widely used peripheral vascular approach for transcatheter aortic valve implantation (TAVI). Despite technical improvement and reduction in delivery sheath diameters of all TAVI platforms, 10-20% of patients remain not eligible to transfemoral TAVI due to peripheral artery disease. In this review, we aim at presenting an update of recent data concerning transfemoral access and percutaneous closure devices. Moreover, we will review peripheral non-transfemoral alternative as well as caval-aortic accesses and discuss the important features to assess with pre-procedural imaging modalities before TAVI.
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Affiliation(s)
- Nils Perrin
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada.,Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
| | - Guillaume Bonnet
- Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, Bordeaux, France
| | - Lionel Leroux
- Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, Bordeaux, France
| | - Réda Ibrahim
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Thomas Modine
- Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, Bordeaux, France
| | - Walid Ben Ali
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada.,Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, Bordeaux, France
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11
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Barker CM, Dahm C. Femoral Access, Hemostasis, and Complications for Transcatheter Aortic Valve Replacement. Interv Cardiol Clin 2021; 10:423-430. [PMID: 34593106 DOI: 10.1016/j.iccl.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Most transcatheter aortic valve replacement procedures are currently performed using a percutaneous transfemoral arterial retrograde approach. Complication rates can be minimized with thorough preprocedure planning, pristine technique, and increased team experience. Vascular complications will continue to happen and require early recognition and treatment.
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Affiliation(s)
- Colin M Barker
- Vanderbilt University Medical Center, Vanderbilt Heart and Vascular Institute, 1215 21st Avenue South, Medical Center East, 5th Floor, Nashville, TN 37232-8802, USA.
| | - Cherie Dahm
- Vanderbilt University Medical Center, Vanderbilt Heart and Vascular Institute, 1215 21st Avenue South, Medical Center East, 5th Floor, Nashville, TN 37232-8802, USA
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12
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Zachoval CF, Sedaghat A, Oezkur M, Tiyerili V, Becher MU, Sinning JM, Treede H, Nickenig G, Zimmer S. Feasibility and Safety of an 8 F Angioseal ® Vascular Closure Device for Closure of Large Bore Impella CP ® Access. J Endovasc Ther 2021; 29:336-342. [PMID: 34560827 DOI: 10.1177/15266028211047965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Percutaneous mechanical circulatory support (pMCS) with the Impella® device is routinely used in cardiogenic shock and high risk percutaneous coronary interventions (PCI). However, safety and feasibility to close the large bore access (LBA) post-hoc remain a challenge. MATERIALS AND METHODS In patients with planned termination of Impella therapy, corresponding LBA closure was attempted using an undersized AngioSeal® device, which was deployed after insertion of a 0.035 in J-wire through the guidewire access port. Cross-over angiographic visualization before and after deployment as well as in-hospital follow up were performed to assess closure success and screening for short-term adverse events. RESULTS We evaluated 17 patients (68 year old, IQR 58-76, 71% male) in whom 14 F LBA closure after pMCS using the Impella CP® was achieved with an undersized AngioSeal® device. Clinical indication for pMCS was cardiogenic shock in 94% and protected PCI in 6%. Impella CP® devices were withdrawn after a median of 4 days (IQR 3-6 days). Primary hemostasis was achieved in the majority of patients (14/17; 82%) while single cross-over balloon inflation led to hemostasis in the remaining patients. One patient suffered acute ischemia later in the course of the disease, but this was not directly related to the closure device. In this study, no major bleeding or other device-related adverse events were observed. CONCLUSION The 8 F AngioSeal® vascular closure device has been safely used for removal of the Impella CP® microaxial pump in most cases of predominantly normal weight patients. This technique may be considered feasible for post-hoc LBA closure in the context of pMCS, especially when preclosure options are not suitable or unavailable.
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Affiliation(s)
- Christian F Zachoval
- Medizinische Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Alexander Sedaghat
- Medizinische Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Mehmet Oezkur
- Klinik und Poliklinik für Herzchirurgie, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Vedat Tiyerili
- Medizinische Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Marc U Becher
- Medizinische Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Jan-Malte Sinning
- Medizinische Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Hendrik Treede
- Klinik und Poliklinik für Herzchirurgie, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Georg Nickenig
- Medizinische Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Medizinische Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
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13
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Sohal S, Tayal R. Mechanical Circulatory Support Devices: Management and Prevention of Vascular Complications. Interv Cardiol Clin 2021; 10:269-279. [PMID: 33745675 DOI: 10.1016/j.iccl.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The use of mechanical circulatory support devices has seen a dramatic rise over the last few years owing to their increased use not only in acute circulatory collapse but also their prophylactic use in high-risk procedures. These devices continue to have their overall benefits marginalized due to the relatively high rates of complications. Vascular complications are the most common and are associated with increased risk of mortality in these patients. Preventive measures at each stage of procedure, frequent monitoring and assessment to recognize early signs of deterioration are the best ways to mitigate the effects of vascular complications.
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Affiliation(s)
- Sumit Sohal
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-Barnabas Heath Newark Beth Israel Medical Center, 201 Lyon Avenue, Newark, NJ 07112, USA
| | - Rajiv Tayal
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-Barnabas Heath Newark Beth Israel Medical Center, 201 Lyon Avenue, Newark, NJ 07112, USA.
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14
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Pott D, Sedaghat A, Schmitz C, Werner N, Schmitz-Rode T, Steinseifer U, Jansen SV. Hemodynamics inside the neo- and native sinus after TAVR: Effects of implant depth and cardiac output on flow field and coronary flow. Artif Organs 2020; 45:68-78. [PMID: 32750157 DOI: 10.1111/aor.13789] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/19/2020] [Accepted: 07/20/2020] [Indexed: 12/22/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a widely used therapy for aortic valve diseases. With TAVR, flow hemodynamics may change leading to areas of flow stagnation prone to thrombosis risk. The neo-sinus, created by introducing a prosthesis inside the diseased native valve, may prompt leaflet thrombosis due to areas of flow stasis. This study attempted to understand the effect of different prosthesis implant depths on the flow field within the neo- and native sinus and on the coronary perfusion. Experiments were performed inside an in vitro pulse duplicator producing physiological conditions according to ISO 5840-1:2015 standard. Flow fields were obtained for two cardiac outputs (CO) using particle image velocimetry (PIV). Washout was calculated as a measure of flow stasis. The two main results are: a lower implant position and a lower CO/frequency led to better native sinus washout, but worsened neo-sinus washout. In contrast, a higher implant position led to higher coronary flow (for higher CO/frequency). No significant effect of implant depth on coronary flow was observed for lower CO/frequency. In summary, a higher implant position using this self-expanding prosthesis is associated with reduced neo-sinus flow stasis. Hereby, washout of the native sinus, as well as coronary flow, are dependent on cardiac output.
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Affiliation(s)
- Desiree Pott
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | | | - Christoph Schmitz
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Nikos Werner
- Innere Medizin III/Kardiologie, Krankenhaus der Barmherzigen Brüder Trier, Trier, Germany
| | - Thomas Schmitz-Rode
- Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Ulrich Steinseifer
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Sebastian Victor Jansen
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Aachen, Germany
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15
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Al-Kassou B, Kandt J, Lohde L, Shamekhi J, Sedaghat A, Tabata N, Weber M, Sugiura A, Fimmers R, Werner N, Grube E, Treede H, Nickenig G, Sinning JM. Safety and Efficacy of Protamine Administration for Prevention of Bleeding Complications in Patients Undergoing TAVR. JACC Cardiovasc Interv 2020; 13:1471-1480. [DOI: 10.1016/j.jcin.2020.03.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/23/2020] [Accepted: 03/31/2020] [Indexed: 12/17/2022]
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16
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Schahab N, Kavsur R, Mahn T, Schaefer C, Kania A, Fimmers R, Nickenig G, Zimmer S. Endovascular management of femoral access-site and access-related vascular complications following percutaneous coronary interventions (PCI). PLoS One 2020; 15:e0230535. [PMID: 32191751 PMCID: PMC7082010 DOI: 10.1371/journal.pone.0230535] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/02/2020] [Indexed: 11/19/2022] Open
Abstract
Background Major vascular complications (VCs) of ilio–femoral arterial access after percutaneous coronary interventions are infrequent, but are associated with increased mortality and morbidity. Routine endovascular repair of VCs is becoming the treatment of choice, especially for patients who cannot tolerate vascular surgery due to advanced cardiovascular disease or are in a bailout situation. Here, we review the different types of vascular access site complications associated with percutaneous coronary interventions (PCIs) and assess the safety and efficacy of endovascular treatment. Methods Data were retrospectively analysed from patients who experienced VCs after transfemoral PCIs, from December 2014 to May 2018. During this period, out of 2833 patients who underwent femoral coronary interventions, 53 (1.9%) experienced major VCs. Results In total, 40/53 (75.5%) cases with major VCs led to unplanned endovascular repair and 13/53 (24.5%) cases required surgical repair. VCs included 17 (32.1%) retroperitoneal bleeding events (BARC-2, 3a,b), 20 (37.7%) intimal dissections, and 16 (30.2%) femoral pseudoaneurysms. Overall, 32 (60.4%) patients received a covered stent, two (3.8%) received a nitinol stent, five (9.4%) patients with dissections were treated with prolonged balloon angioplasty alone, and one patient with femoral pseudoaneurysm underwent thrombin injection with simultaneous balloon occlusion. The mean hospital stay for patients after endovascular treatment was 11.06 ± 5.2 days, while for patients after surgical repair it was 17 ± 8.2 days. Endovascularly treated patients were transfused with red blood cells (13/40 32.5% vs. 2/13 15.4%) significantly more often than patients treated surgically, although surgically treated patients received more red blood cell concentrates per unit than endovascularly treated patients (1 ± 0.47 vs. 2 ± 0.93). During the one-year follow-up, no intermittent claudication was reported, and no patient required secondary endovascular or surgical repair. Conclusions For patients who cannot tolerate vascular surgery due to advanced cardiovascular disease or are in a bailout situation, endovascular management of VCs following PCIs seems to be a feasible and safe treatment option, and represents an alternative to surgical repair in life-threatening situations. Endovascular treatment was associated with significantly fewer red blood cell concentrates per patient and fewer days in hospital than surgical treatment.
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Affiliation(s)
- Nadjib Schahab
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
- * E-mail:
| | - Refik Kavsur
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
| | - Thorsten Mahn
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
| | - Christian Schaefer
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
| | - Alexander Kania
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Rolf Fimmers
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
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17
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Laakso T, Moriyama N, Raivio P, Dahlbacka S, Kinnunen EM, Juvonen T, Valtola A, Husso A, Jalava MP, Ahvenvaara T, Tauriainen T, Piuhola J, Lahtinen A, Niemelä M, Mäkikallio T, Virtanen M, Maaranen P, Eskola M, Savontaus M, Airaksinen J, Biancari F, Laine M. Impact of Major Vascular Complication Access Site Status on Mortality After Transfemoral Transcatheter Aortic Valve Replacement - Results From the FinnValve Registry. Circ Rep 2020; 2:182-191. [PMID: 33693226 PMCID: PMC7921363 DOI: 10.1253/circrep.cr-20-0007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: The aim of this study was to investigate the impact of anatomical site status and major vascular complication (MVC) severity on the outcome of transfemoral transcatheter aortic valve replacement (TF-TAVR). Methods and Results: The FinnValve registry enrolled consecutive TAVR patients from 2008 to 2017. MVC was divided into 2 groups: non-access site-related MVC (i.e., MVC in aorta, aortic valve annulus or left ventricle); and access site-related MVC (i.e., MVC in iliac or femoral arteries). Severity of access site-related MVC was measured as units of red blood cell (RBC) transfusion. Of 1,842 patients who underwent TF-TAVR, 174 had MVC (9.4%; non-access site related, n=29; access site related, n=145). Patients with MVC had a significantly higher 3-year mortality than those without MVC (40.8% vs. 24.3%; HR, 2.01; 95% CI: 1.16-3.62). Adjusted 3-year mortality risk was significantly increased in the non-access site-related MVC group (mortality, 77.8%; HR, 4.30; 95% CI: 2.63-7.02), but not in the access site-related MVC group (mortality, 32.6%; HR, 1.38; 95% CI: 0.86-2.15). In the access site-related MVC group, only those with RBC transfusion ≥4 units had a significantly increased 3-year mortality risk (mortality, 51.8%; HR, 2.18; 95% CI: 1.19-3.89). Conclusions: In patients undergoing TF-TAVR, MVC was associated with an increased 3-year mortality risk, incrementally correlating with anatomical site and bleeding severity.
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Affiliation(s)
- Teemu Laakso
- Heart and Lung Center, Helsinki University Hospital Helsinki Finland
| | - Noriaki Moriyama
- Heart and Lung Center, Helsinki University Hospital Helsinki Finland
| | - Peter Raivio
- Heart and Lung Center, Helsinki University Hospital Helsinki Finland
| | | | | | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital Helsinki Finland
| | - Antti Valtola
- Heart Center, Kuopio University Hospital Kuopio Finland
| | | | - Maina P Jalava
- Heart Center, Turku University Hospital and University of Turku Turku Finland
| | - Tuomas Ahvenvaara
- Department of Surgery, Oulu University Hospital and University of Oulu Oulu Finland
| | - Tuomas Tauriainen
- Department of Surgery, Oulu University Hospital and University of Oulu Oulu Finland
| | - Jarkko Piuhola
- Department of Internal Medicine, Oulu University Hospital Oulu Finland
| | - Asta Lahtinen
- Department of Internal Medicine, Oulu University Hospital Oulu Finland
| | - Matti Niemelä
- Department of Internal Medicine, Oulu University Hospital Oulu Finland
| | - Timo Mäkikallio
- Department of Internal Medicine, Oulu University Hospital Oulu Finland
| | - Marko Virtanen
- Heart Hospital, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University Tampere Finland
| | - Pasi Maaranen
- Heart Hospital, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University Tampere Finland
| | - Markku Eskola
- Heart Hospital, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University Tampere Finland
| | - Mikko Savontaus
- Heart Center, Turku University Hospital and University of Turku Turku Finland
| | - Juhani Airaksinen
- Heart Center, Turku University Hospital and University of Turku Turku Finland
| | - Fausto Biancari
- Heart Center, Turku University Hospital and University of Turku Turku Finland.,Department of Surgery, Oulu University Hospital and University of Oulu Oulu Finland.,Department of Surgery, University of Turku Turku Finland
| | - Mika Laine
- Heart and Lung Center, Helsinki University Hospital Helsinki Finland
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18
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Drouelle E, De Poli F, Couppie P, Uhry S, Heyer H, Morel O, Ohlmann P, Hess S, Kibler M, Leddet P. [Common femoral artery bailout stenting with covered stent graft due to TAVR vascular complication: Clinical long term follow-up]. Ann Cardiol Angeiol (Paris) 2019; 68:316-324. [PMID: 31570157 DOI: 10.1016/j.ancard.2019.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 08/28/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vascular complications are frequent in the context of transcatheter aortic valve replacement and may require the implantation of a covered stent graft in the common femforal artery. However, common femoral artery is considered to be at high risk of stent fracture or occlusion due to high mobility of the hip joint. PATIENTS AND METHODS We analyzed medical records of patients with transcatheter aortic valve replacement related vascular complications between 2015 and 2018, treated with commom femoral artery transluminal angioplasty or surgery. Vascular complications or suspect symptoms were followed up by phone calls. RESULTS Among 552 patients, 43 patients were included. Twelve (11.6 %) were managed by prolonged balloon inflation, 5 (11.6 %) by first line surgery and 26 (60.4 %) by the implantation of a covered stent graft. Among the latter group, the covered stent graft was efficient in 24 patients (92.3 %). The median follow-up was 430 days [3-1499]. The first-line surgery group had a higher risk of red blood cell transfusion and all causes mortality. At follow-up, no patient had suspicious symptoms of vascular covered stent complication. Four patients (9.3 %) had US-doppler or CT vascular imaging at follow-up, showing no evidence of stent fracture or occlusion. CONCLUSION In our study, the implantation of a covered stent graft in the common femoral artery was an efficient and safe strategy for the management of transcatheter aortic valve replacement related vascular complications.
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Affiliation(s)
- E Drouelle
- Service de cardiologie, Centre hospitalier Haguenau, 67, avenur du Pr René-Leriche, 67 500 Haguenau.
| | - F De Poli
- Service de cardiologie, Centre hospitalier Haguenau, 67, avenur du Pr René-Leriche, 67 500 Haguenau
| | - P Couppie
- Service de cardiologie, Centre hospitalier Haguenau, 67, avenur du Pr René-Leriche, 67 500 Haguenau
| | - S Uhry
- Service de cardiologie, Centre hospitalier Haguenau, 67, avenur du Pr René-Leriche, 67 500 Haguenau
| | - H Heyer
- Service de cardiologie, Centre hospitalier Haguenau, 67, avenur du Pr René-Leriche, 67 500 Haguenau
| | - O Morel
- Service de cardiologie, CHU de Strasbourg, 1, place de l'Hôpital, 67 000 Strasbourg
| | - P Ohlmann
- Service de cardiologie, CHU de Strasbourg, 1, place de l'Hôpital, 67 000 Strasbourg
| | - S Hess
- Service de cardiologie, CHU de Strasbourg, 1, place de l'Hôpital, 67 000 Strasbourg
| | - M Kibler
- Service de cardiologie, CHU de Strasbourg, 1, place de l'Hôpital, 67 000 Strasbourg
| | - P Leddet
- Service de cardiologie, Centre hospitalier Haguenau, 67, avenur du Pr René-Leriche, 67 500 Haguenau
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19
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Sedaghat A, Hansen KL, Schahab N, May MC, Weber M, Stundl A, Shamekhi J, Schaefer C, Nickenig G, Sinning JM, Lönn L, Søndergaard L, Werner N, De Backer O. 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 2018; 281:42-46. [PMID: 30711261 DOI: 10.1016/j.ijcard.2018.12.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/23/2018] [Accepted: 12/18/2018] [Indexed: 11/29/2022]
Abstract
AIMS Stent graft placement is a safe and effective treatment option for vascular complications in the context of transcatheter aortic valve implantation (TAVI). This study aimed to provide long-term angiological follow-up of stent grafts used for this indication. METHODS AND RESULTS Seventy-one patients (64.8% female, log EuroScore 14.7 ± 6.8%) who had undergone TAVI between March 2010 and October 2015 with implantation of a Viabahn or Fluency stent graft to treat access-site or access-related vascular injury (ASARVI) were analyzed. Implantations were mostly due to access-site bleeding complications (83.1%) in the common femoral artery (97.1%). Follow-up was performed with duplex sonography in all patients after a median of 3.9 years after TAVI (interquartile range [IQR]: 895-1749 days). Ultrasound revealed tri- or biphasic flow patterns in 16.9% and 77.6%, respectively. Stent graft patency was 100% without signs of stent graft stenosis (mean peak velocity ratio 1.0 ± 0.2). Pseudo-aneurysms or endoleaks were diagnosed in 5.6% of patients. Additional fluoroscopic and/or computed tomography (CT)-imaging was available in 36.6% of patients and did not reveal any stent fracture. CONCLUSION Self-expanding stent grafts provide excellent long-term function with few complications when implanted in the context of TAVI-related ASARVI.
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Affiliation(s)
- Alexander Sedaghat
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
| | | | - Nadjib Schahab
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
| | - Maria Cesarina May
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
| | - Marcel Weber
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
| | - Anja Stundl
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
| | - Jasmin Shamekhi
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
| | - Christian Schaefer
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
| | - Georg Nickenig
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
| | - Jan-Malte Sinning
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
| | - Lars Lönn
- Cardiovascular Radiology, Faculty of Health Sciences, Rigshospitalet, Copenhagen, Copenhagen, Denmark
| | | | - Nikos Werner
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany.
| | - Ole De Backer
- Heart Center - Rigshospitalet Copenhagen, Copenhagen, Denmark
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20
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Long-Term Outcomes of Iliofemoral Artery Stents after Transfemoral Aortic Valve Replacement. J Vasc Interv Radiol 2018; 29:1733-1740. [PMID: 30297312 DOI: 10.1016/j.jvir.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/01/2018] [Accepted: 06/03/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To report long-term results of iliofemoral stent placement after transcatheter aortic valve replacement (TAVR). MATERIALS AND METHODS TAVR access-related complications treated with iliofemoral stent placement were recorded in 56 patients (mean age, 81 years; range; 53-93 years; 48% male) of 648 patients who underwent TAVR at a single center. Fifty-six patients treated with stent placement (40 patients with stent grafts and 16 patients with bare metal stents) underwent clinical and ultrasonographic follow-up after a mean of 676 days (range, 60-1840 days). RESULTS During follow-up, none of the 56 patients who had stent placement underwent a vascular reintervention of the affected limb, and none suffered from limb claudication. No decrease was observed in ankle-brachial index (ABI) values to an abnormal value, except in 1 patient (mean preprocedural and postprocedural ABI of 1.2 ± 0.14, range, 0.97-1.4 and 1.19 ± 0.24, range, 0.65-1.54, respectively). Arterial duplex assessment showed normal stent flow velocity (mean, 168.7 ± 63.2 cm/sec; range, 80-345 cm/sec) in all but 1 patient. CONCLUSION Iliofemoral stent implantation is a safe and efficacious treatment for vascular access site and access-related complications during transfemoral TAVR.
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21
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Veulemans V, Afzal S, Ledwig P, Heiss C, Busch L, Sansone R, Soetemann DB, Maier O, Kleinebrecht L, Kelm M, Zeus T, Hellhammer K. Stent fractures after common femoral artery bail-out stenting due to suture device failure in TAVR. VASA 2018; 47:393-401. [PMID: 29952252 DOI: 10.1024/0301-1526/a000712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Vascular access site-related complications are frequent in the context of transfemoral transcatheter aortic valve replacement (TAVR). The implantation of a covered stent graft is an effective treatment option for bleeding control. However, the external iliac and common femoral arteries are exposed to flexion of the hip joint. Therefore, stent compression and stent/strut fractures may occur, facilitating stent occlusion. PATIENTS AND METHODS In all 389 patients who received transfemoral TAVR from 2013-2015 at the Düsseldorf Heart Centre, we monitored the management of vascular access site-related complications. Our analyses focused on immediate technical success and bleeding control, primary patency, and the occurrence of stent/strut fractures after six to 12 months of follow-up. RESULTS Vascular access site-related complications occurred in 13 % (n = 51), whereof in 10 patients, the bleeding was successfully managed by prolonged compression. In 40 out of 51 patients, a covered stent graft was implanted in the common femoral artery, leading to 100 % immediate bleeding control. After a mean follow-up of 334 ± 188 days, 28 stents out of 29 patients with completed follow-up (excluding e. g. death) were without flow-limiting stenosis (primary patency 97 %) or relevant stent compression (diameter pre/post 8.6/8.1 mm, p = 0.048, late lumen loss 1.1 ± 0.2 mm, mean flow velocity 92 ± 34 cm/s). In four asymptomatic patients, stent/strut fractures were detected (14 %) without flow-limiting stenosis. CONCLUSIONS The implantation of a covered stent graft is highly effective and safe to control vascular access site-related complications after TAVR. Stent/strut fractures in the flexible segment of the common femoral artery may occur, as consequently verified by X-ray visualization, but show no impairment on flow or clinical parameters after six to 12 months.
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Affiliation(s)
- Verena Veulemans
- 1 Division of Cardiology, Pulmonary Diseases, Vascular Medicine, Medical Faculty, University Düsseldorf, Germany.,a These authors contributed equally to this paper
| | - Shazia Afzal
- 1 Division of Cardiology, Pulmonary Diseases, Vascular Medicine, Medical Faculty, University Düsseldorf, Germany.,a These authors contributed equally to this paper
| | - Paul Ledwig
- 1 Division of Cardiology, Pulmonary Diseases, Vascular Medicine, Medical Faculty, University Düsseldorf, Germany
| | - Christian Heiss
- 1 Division of Cardiology, Pulmonary Diseases, Vascular Medicine, Medical Faculty, University Düsseldorf, Germany
| | - Lucas Busch
- 1 Division of Cardiology, Pulmonary Diseases, Vascular Medicine, Medical Faculty, University Düsseldorf, Germany
| | - Roberto Sansone
- 1 Division of Cardiology, Pulmonary Diseases, Vascular Medicine, Medical Faculty, University Düsseldorf, Germany
| | - Dagmar B Soetemann
- 1 Division of Cardiology, Pulmonary Diseases, Vascular Medicine, Medical Faculty, University Düsseldorf, Germany
| | - Oliver Maier
- 1 Division of Cardiology, Pulmonary Diseases, Vascular Medicine, Medical Faculty, University Düsseldorf, Germany
| | - Laura Kleinebrecht
- 1 Division of Cardiology, Pulmonary Diseases, Vascular Medicine, Medical Faculty, University Düsseldorf, Germany
| | - Malte Kelm
- 1 Division of Cardiology, Pulmonary Diseases, Vascular Medicine, Medical Faculty, University Düsseldorf, Germany.,2 CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Tobias Zeus
- 1 Division of Cardiology, Pulmonary Diseases, Vascular Medicine, Medical Faculty, University Düsseldorf, Germany
| | - Katharina Hellhammer
- 1 Division of Cardiology, Pulmonary Diseases, Vascular Medicine, Medical Faculty, University Düsseldorf, Germany
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22
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van Kesteren F, van Mourik MS, Vendrik J, Wiegerinck EM, Henriques JP, Koch KT, Wykrzykowska JJ, de Winter RJ, Piek JJ, van Lienden KP, Reekers JA, Vis MM, Planken RN, Baan J. Incidence, Predictors, and Impact of Vascular Complications After Transfemoral Transcatheter Aortic Valve Implantation With the SAPIEN 3 Prosthesis. Am J Cardiol 2018; 121:1231-1238. [PMID: 29703437 DOI: 10.1016/j.amjcard.2018.01.050] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/20/2018] [Accepted: 01/30/2018] [Indexed: 12/20/2022]
Abstract
Vascular complications (VCs) after transfemoral transcatheter aortic valve implantation (TAVI) have always been reported to occur frequently. Studies addressing VCs have been conducted with older-generation prostheses. We aimed to evaluate the incidence, predictors, and impact of VCs after transfemoral TAVI with the balloon-expandable SAPIEN 3. We report a single-center retrospective analysis of 400 consecutive patients of a prospectively acquired cohort. All patients underwent transfemoral TAVI with SAPIEN 3 between January 2014 and December 2016. VC was defined according to the Valve Academic Research Consortium. In this cohort 83 patients had VCs (20.8%), 5.8% major and 15.0% minor. Sheath-to-iliofemoral artery ratio was the only predictor of major VCs (odds ratio 7.51, 95% confidence interval 1.61 to 34.95, p = 0.010). The area under the receiver-operator characteristic curve for sheath-to-iliofemoral artery ratio was 0.63 (poor accuracy). Thirty-day mortality rates were 17.4%, 1.7%, and 0.6% for major, minor, and no VCs, respectively (log-rank p ≤0.001). After adjustment, only major VCs were associated with 30-day mortality (adjusted hazard ratio 48.31, 95% confidence interval 7.80 to 299.24). Mortality from 30 days until 1 year did not differ between patients with and without VCs (log-rank p = 0.61). In conclusion we report that VCs remain an issue of transfemoral TAVI with the SAPIEN 3, and their prediction continues to be difficult, albeit the low-incidence, major VCs were associated with higher 30-day mortality. However, after these first 30 days, they were not of influence on survival anymore.
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Segal A, Flugelman MY, Khader N, Rubinshtein R, Lavi I, Karmeli R, Jubran A, Shiran A, Jaffe R. Outcome of Stent Graft Implantation for Treatment of Access Site Bleeding After Transfemoral Transcatheter Aortic Valve Replacement. Am J Cardiol 2017; 120:456-460. [PMID: 28583682 DOI: 10.1016/j.amjcard.2017.04.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 04/25/2017] [Accepted: 04/25/2017] [Indexed: 12/17/2022]
Abstract
Vascular complications are common after transcatheter aortic valve replacement (TAVR) and are associated with increased morbidity and mortality. Stent graft implantation enables percutaneous treatment of access site bleeding; however, the efficacy and durability and of this approach are unknown. We studied the immediate outcome of stent graft implantation for control of access site bleeding and the need for repeat vascular interventions after stenting, in a cohort of consecutive patients with severe symptomatic aortic stenosis who underwent transfemoral TAVR. Predictors of access site complications requiring percutaneous or surgical vascular repair were identified. Transfemoral TAVR was performed in 194 patients. Access site complications requiring urgent vascular repair occurred in 34 patients (18%). Stent graft implantation was performed in 31 patients and vascular surgery in 3 patients. When patients who required surgical or percutaneous vascular repair were compared with those who did not, increased body mass index (30 ± 6 vs 28 ± 5, p = 0.035) and reduced activated clotting time (233 ± 47 vs 252 ± 47, p = 0.030) were the only predictors of need for vascular repair. Stenting achieved adequate hemostasis in all patients with a single minor vascular complication. During median follow-up of 797 days (interquartile range 585 to 1,173), no clinically significant vascular complications were detected after stenting. In conclusion, control of bleeding was achieved in all patients who underwent stent graft implantation for treatment of access site vascular complications after transfemoral TAVR. None of these patients needed further vascular interventions during follow-up.
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Ando T, Akintoye E, Telila T, Briasoulis A, Takagi H, Grines CL, Afonso L. Trends in Vascular Complications in High-Risk Patients Following Transcatheter Aortic Valve Replacement in the United States. Am J Cardiol 2017; 119:1433-1437. [PMID: 28256249 DOI: 10.1016/j.amjcard.2017.01.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 01/09/2023]
Abstract
Vascular complications (VC) following transcatheter aortic valve replacement (TAVR) are associated with worse outcomes. The trend of VC incidence in patients considered high risk is unclear. We sought to assess the trend of VC after TAVR in patients at high risk. We investigated the VC trend in female, diabetes mellitus, and peripheral vascular disease (PVD) patients. Patients who underwent TAVR from 2011 to 2014 in the United States were identified using the International Classification of Diseases-Ninth Revision code 35.05 from the Nationwide Inpatient Sample database. Frequency of any VC (per 100 transcatheter aortic valve implantation procedure or hospital discharges) for each year from 2011 to 2014 was assessed for the overall population as well as within each category of high-risk cohorts. The overall VC rate was 6.0% (2,044/33,790). Patients who had VC were more likely to be female and had higher rates of PVD at baseline. The annual rate of VC in the overall population from 2011 to 2014 was 4.6%, 9.4%, 6.8%, and 4.4%, respectively. There was a significant increase in VC rate from 2011 to 2012 (p = 0.03), whereas there was a significant decrease in VC rate from 2012 to 2014 (p <0.001). The rate of VC between 2011 and 2014 was similar (p = 0.82). The rate of VC did not increase in any of the high-risk groups from 2011 to 2012. However, the rate of VC from 2012 to 2014 decreased significantly in all the high-risk groups. The VC rate was similar for groups between 2011 and 2014. The overall VC rate among TAVR patients initially increased from 2011 to 2012 but decreased thereafter. Similar trend in VC rate was found among high-risk patients except that the initial increase in rates from 2011 to 2012 did not reach statistical significance. Whether further reduction in VC with improvement in devices and operator/center experience for both overall and high-risk groups in TAVR occurs will require continuous longitudinal monitoring.
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Affiliation(s)
- Tomo Ando
- Division of Cardiology, Wayne State University, Harper University/Detroit Medical Center, Detroit, Michigan.
| | - Emmanuel Akintoye
- Division of Cardiology, Wayne State University, Harper University/Detroit Medical Center, Detroit, Michigan
| | - Tesfaye Telila
- Division of Cardiology, Wayne State University, Harper University/Detroit Medical Center, Detroit, Michigan
| | | | - Hisato Takagi
- Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Cindy L Grines
- Division of Cardiology, Detroit Medical Center, Detroit, Michigan
| | - Luis Afonso
- Division of Cardiology, Wayne State University, Harper University, Detroit, Michigan
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Harjai KJ, Grines CL, Paradis JM, Kodali S. Transcatheter aortic valve replacement: The year in review 2016. J Interv Cardiol 2017; 30:105-113. [PMID: 28256067 DOI: 10.1111/joic.12372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 01/01/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) continued to make major strides in 2016, simultaneously expanding its application to lower risk patients as well as more technically challenging subsets of patients with aortic stenosis (AS). The two major accomplishments this year were the establishment of TAVR as the preferred treatment strategy over surgical aortic valve replacement (SAVR) in intermediate risk patients, and initial signals that TAVR and SAVR may be clinically equivalent in low-risk populations. Meanwhile, there is continued expansion of TAVR to challenging clinical subsets (bicuspid aortic valve [BAV], patients with concomitant advanced coronary artery disease [CAD], and failed surgical bioprostheses), and encouraging initial experiences with newer transcatheter heart valve systems. This paper summarizes the major research studies published on TAVR in 2016.
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Affiliation(s)
- Kishore J Harjai
- Geisinger Clinic, Pearsall Heart Hospital, Wilkes-Barre, Pennsylvania
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Sedaghat A, Kulka H, Sinning JM, Falkenberg N, Driesen J, Preisler B, Hammerstingl C, Nickenig G, Pötzsch B, Oldenburg J, Hertfelder HJ, Werner N. Transcatheter aortic valve implantation leads to a restoration of von Willebrand factor (VWF) abnormalities in patients with severe aortic stenosis – Incidence and relevance of clinical and subclinical VWF dysfunction in patients undergoing transfemoral TAVI. Thromb Res 2017; 151:23-28. [DOI: 10.1016/j.thromres.2016.12.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 12/20/2016] [Accepted: 12/28/2016] [Indexed: 10/20/2022]
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