Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) has rapidly developed over the last decade and is nowadays the treatment of choice in the elderly patients irrespective of surgical risk. The outcome of these patients is mainly determined not only by the interventional procedure itself, but also by its complications.Material and Methods: We analyzed the outcome and procedural events of transfemoral TAVI procedures performed per year at our institution. The mean age of these patients is 79.2 years and 49% are female. All the patients underwent duplex ultrasonography of the iliac arteries and inguinal vessels before the procedure and CT of the aorta and iliac arteries.Results: Transfemoral access route is associated with a number of challenges and complications, especially in the patients suffering from peripheral artery disease (PAD). The rate of vascular complications at our center was 2.76% (19/689). Typical vascular complications (VC) include bleeding and pseudoaneurysms at the puncture site, acute or subacute occlusion of the access vessel, and dissection or perforation of the iliac vessels. In addition, there is the need for primary PTA of the access pathway in the presence of additional PAD of the common femoral artery (CFA) and iliac vessels. Balloon angioplasty, implantation of covered and uncovered stents, lithoplasty, and ultrasound-guided thrombin injection are available to treat the described issues.Conclusion: Interventional therapy of access vessels can preoperatively enable the transfemoral approach and successfully treat post-operative VC in most of the cases. Training the heart team to address these issues is a key focus, and an interventional vascular specialist should be part of this team.
Highlights
Transcatheter aortic valve implantation (TAVI) has rapidly developed over the last decade and is nowadays the treatment of choice in the elderly patients irrespective of surgical risk
All the patients underwent interventional attempt to resolve the complications related to the access vessels, which occurred during the TAVI procedure, or as barriers to a planned TAVI as well
The bleeding occurs for some time after TAVI, for example, with the appearance of a retroperitoneal hematoma or malfunction of the vascular closure device
Summary
Transcatheter aortic valve implantation (TAVI) has rapidly developed over the last decade and is nowadays the treatment of choice in the elderly patients irrespective of surgical risk The outcome of these patients is mainly determined by the interventional procedure itself, and by its complications. Transcatheter aortic valve implantation (TAVI) has evolved rapidly over the past decade and is the treatment of choice in the patients over 70 years of age, regardless of surgical risk [1]. The outcome of these patients, especially at the low surgical risk, is essentially determined by the interventional procedure itself, and by its complications [2]. An ultrasoundguided puncture has the potential to significantly reduce the rate of access site complications [9, 10]
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