Feasibility and outcomes of interventional treatment for vascular access site complications following transfemoral aortic valve implantation.

Abstract

Despite the completion of more than 60,000 transcutaneous aortic valve implantations (TAVI) per year and an approximately 10-15% incidence of vascular access site complications (VAC), there is a paucity of data on the efficacy and safety of percutaneous VAC treatment. Percutaneous endovascular treatment will be an effective treatment of VAC and associated with a low rate of surgical repair. Despite stent placement in proximity to the hip joint, endovascular treatment will be only rarely associated with disabling symptoms or complications. We conducted a retrospective database analysis including 355 patients who underwent TAVI from January 2011 to October 2015. To facilitate the detection of secondary complications of interventional VAC repair, we conducted structured telephone interviews with a focus on new diagnoses or symptoms of peripheral artery disease. Only four patients (1.1%) required surgical treatment for VAC. Percutaneous balloon angioplasty (PTA) or stent implantation was required for VAC in 44 patients (12.4%). The technical success rate of percutaneous VAC treatment was 93%. Four patients died within 30days of VAC treatment, but only one fatality was directly attributable to VAC. Post procedure mean hospital stay was numerically prolonged by 2.4days in the VAC treatment group (P=0.06). During a median follow-up of 385days (range 89-909days) none of the patients were diagnosed with a late VAC or reported a new diagnosis or symptoms of perfusion deficit or peripheral artery disease. Percutaneous treatment of VAC during TAVI is safe and effectively helps to minimize the need for surgery in the vast majority of VAC. During short- and mid-term follow-up, percutaneous VAC management is associated with low complication rates and good clinical outcomes.