Transcatheter Aortic Valve Replacement: Full Unilateral Access Using the Ipsilateral Superficial Femoral Artery Is Effective

BACKGROUND: Access site complications are very common complications in transcatheter aortic valve replacement (TAVR). Usually, a second arterial sheath is placed either in the contralateral femoral artery or in the radial artery as a simplified approach. This study aimed to investigate the safety and effectiveness of a full unilateral access using the ipsilateral superficial femoral artery (iSFA) in TAVR and to determine whether it simplifies the procedure. METHODS: This single-center retrospective audit analyzed the first 100 TAVR cases between February 2022 and January 2023 using iSFA as default secondary access. The primary outcomes included 30-day device success, bleeding, and vascular access-related complications. The last 100 bilateral cases and all bilateral cases (n = 656) served as controls. RESULTS: Of the 143 transfemoral TAVRs performed during the study period, 43 patients were excluded. The remaining 100 patients (median age, 84 years; interquartile range, 80-89 years; median EuroSCORE II, 2.46; interquartile range, 1.65-3.97) were analyzed. The vascular access-related complication rates were 11% (main access, 55%; secondary access, 45%), with a 97% device success rate. In the control group of all bilateral cases, device success and vascular access-related complication rates were 93% and 17%, respectively. In the experimental group, access complications were promptly managed in the catheterization laboratory. All cases requiring interventions other than manual compression were successfully managed using iSFA. CONCLUSIONS: The total unilateral approach using iSFA was safe and effective, shortening the time to address main access complications, providing ergonomic advantages for operators, and enhancing patient comfort.