0219 : Outcomes of patients undergoing femoral covered stent graft during percutaneous transcatheter aortic valve implantation

Abstract

Although vascular complications are frequent after percutaneous transcatheter aortic valve implantation (TAVI), they can be managed percutaneously most of the time by implanting a covered stent graft in the femoral artery. To evaluate the characteristics of patients who required femoral stent implantation after TAVI and to determine the long-term impact of stent placement in the femoral position. Between January 2011 and December 2013, 320 patients underwent transfemoral TAVI in our center using the Edwards Sapien XT valve. After gaining vascular access, a pre-closure technique was performed with a 10-F ProStar XL closure device followed by16 to 20-F sheath insertion for 23, 26 or 29mm valve implantation. After valve implantation and sheath removal, access site was closed with the ProStar device. An ilio-femoral angiography was performed via the contralateral femoral artery to assess final result and a self-expandable covered stent graft was placed at the level of vessel injury in case of persistent bleeding despite prolonged manual compression or balloon occlusion. Follow-up was performed by phone call and duplex ultrasonography of the access site. 29 (9%) patients required emergency femoral covered stent graft implantation. Patients characteristics were comparable to those of patients who did not require stent implantation except for previous anticoagulant therapy which was significantly associated with stent implantation (44.8% vs 27.1%, p = 0.045). Despite stent implantation, 2 patients underwent surgery for persistent bleeding. Stent implantation did not affect survival (p=0.456). At a median follow-up of 23 months, only 1 patient complained of groin discomfort impacting his daily life. Neither stent fracture nor occlusion was noted by ultrasonography. Vascular complications after TAVI can be safely treated percutaneously by femoral covered stent graft with minimal long-term functional impairment and no impact on survival.