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

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, b...

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Autores principales:	Marcus Thieme, Sven Moebius-Winkler, Marcus Franz, Laura Baez, Christian P. Schulze, Christian Butter, Christoph Edlinger, Daniel Kretzschmar
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	TAVI—transcatheter aortic valve implantation PAD—peripheral arterial disease interventional treatment access site complication (ASC) pseudoaneurysms access site bleeding Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/8d7ee61ca5684236a69574d0fd62cb6d
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spelling	oai:doaj.org-article:8d7ee61ca5684236a69574d0fd62cb6d2021-11-15T05:48:27ZInterventional Treatment of Access Site Complications During Transfemoral TAVI: A Single Center Experience2297-055X10.3389/fcvm.2021.725079https://doaj.org/article/8d7ee61ca5684236a69574d0fd62cb6d2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.725079/fullhttps://doaj.org/toc/2297-055XIntroduction: 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.Marcus ThiemeMarcus ThiemeSven Moebius-WinklerMarcus FranzLaura BaezChristian P. SchulzeChristian ButterChristian ButterChristoph EdlingerChristoph EdlingerDaniel KretzschmarFrontiers Media S.A.articleTAVI—transcatheter aortic valve implantationPAD—peripheral arterial diseaseinterventional treatmentaccess site complication (ASC)pseudoaneurysmsaccess site bleedingDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	TAVI—transcatheter aortic valve implantation PAD—peripheral arterial disease interventional treatment access site complication (ASC) pseudoaneurysms access site bleeding Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	TAVI—transcatheter aortic valve implantation PAD—peripheral arterial disease interventional treatment access site complication (ASC) pseudoaneurysms access site bleeding Diseases of the circulatory (Cardiovascular) system RC666-701 Marcus Thieme Marcus Thieme Sven Moebius-Winkler Marcus Franz Laura Baez Christian P. Schulze Christian Butter Christian Butter Christoph Edlinger Christoph Edlinger Daniel Kretzschmar Interventional Treatment of Access Site Complications During Transfemoral TAVI: A Single Center Experience
description	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.
format	article
author	Marcus Thieme Marcus Thieme Sven Moebius-Winkler Marcus Franz Laura Baez Christian P. Schulze Christian Butter Christian Butter Christoph Edlinger Christoph Edlinger Daniel Kretzschmar
author_facet	Marcus Thieme Marcus Thieme Sven Moebius-Winkler Marcus Franz Laura Baez Christian P. Schulze Christian Butter Christian Butter Christoph Edlinger Christoph Edlinger Daniel Kretzschmar
author_sort	Marcus Thieme
title	Interventional Treatment of Access Site Complications During Transfemoral TAVI: A Single Center Experience
title_short	Interventional Treatment of Access Site Complications During Transfemoral TAVI: A Single Center Experience
title_full	Interventional Treatment of Access Site Complications During Transfemoral TAVI: A Single Center Experience
title_fullStr	Interventional Treatment of Access Site Complications During Transfemoral TAVI: A Single Center Experience
title_full_unstemmed	Interventional Treatment of Access Site Complications During Transfemoral TAVI: A Single Center Experience
title_sort	interventional treatment of access site complications during transfemoral tavi: a single center experience
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/8d7ee61ca5684236a69574d0fd62cb6d
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Interventional Treatment of Access Site Complications During Transfemoral TAVI: A Single Center Experience

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