AUTHOR=Thieme Marcus , Moebius-Winkler Sven , Franz Marcus , Baez Laura , Schulze Christian P. , Butter Christian , Edlinger Christoph , Kretzschmar Daniel 

TITLE=Interventional Treatment of Access Site Complications During Transfemoral TAVI: A Single Center Experience

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.725079

DOI=10.3389/fcvm.2021.725079

ISSN=2297-055X

ABSTRACT=Introduction: Transcatheter aortic valve implantation (TAVI) has rapidly developed over the last decade and is nowadays the treatment of choice in elderly patients irrespective of surgical risk. Outcome of these patients is mainly determined not only by the interventional procedure itself, but also by its complications. 
Material and Methods: We analyzed 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 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 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, as well as dissection or perforation of the iliac vessels. In addition, there is the need for primary PTA of the access pathway in presence of additional PAD of the 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 as well as successfully treat post-operative VC in most cases. Training the heart team to address these issues is a key focus, and an interventional vascular specialist should be part of this team.