Abstract Background Diabetes mellitus (DM) is associated with peripheral artery disease (PAD) and may increase the risk of vascular complications (VC) in patients with hostile femoral access undergoing TAVI. Aims To evaluate the association between DM, VC and clinical outcomes in this population. Methods and Results The HOSTILE registry is an international study including consecutive patients undergoing TAVI with hostile femoral access, defined as severe bilateral iliofemoral PAD requiring percutaneous transluminal angioplasty or alternative access. Outcomes of patients with and without diabetes were compared and stratified by access strategy. Inverse probability of treatment weighting (IPTW) was used to adjust for baseline differences. The primary endpoint was VC of any vascular access. Secondary endpoints included major and minor VC and 30-day and one-year clinical outcomes. Among 1707 patients, 559 (32.7%) had diabetes. Diabetic patients had a higher burden of comorbidities and more severe PAD, represented by higher Hostile scores. Despite this, rates of VC were similar between diabetic and non-diabetic patients (IPTW-adjusted odds ratio 0.86, 95% confidence interval 0.68–1.08, p=0.184), consistently across access strategies. 30-day and one-year all-cause mortality and ischemic outcomes did not differ between groups. DM was associated with a lower incidence of any bleeding at one year, driven by minor bleeding events. Conclusion In patients with hostile femoral anatomy undergoing TAVI, diabetes was associated with more severe PAD but not with an increased risk of VC, mortality, or ischemic events. These findings support the feasibility and safety of contemporary TAVI strategies in diabetic patients with complex peripheral anatomy.
Tartaglia et al. (Fri,) studied this question.