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

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 complication1 . 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 evidence2. 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 pTFTAVI 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 in Table 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 in Table 2. 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 lifestylelimiting claudication. [ABSTRACT FROM AUTHOR]