Computed tomography defined femoral artery plaque composition predicts vascular complications during transcatheter aortic valve implantation

Purpose Vascular and bleeding complications after transcatheter aortic valve implantation (TAVI) are common and lead to increased morbidity and mortality. Analysis of plaque at the arterial access site may improve prediction of complications. Methods We investigated the association between demographic and procedural risk factors for Valve Academic Research Consortium (VARC) vascular complications, as well as a novel method of quantifying plaque composition of the common femoral artery using computed tomography angiography plaque maps created with patient specific x-ray attenuation cut-offs. The relationship between time to haemostasis after TAVI with demographic and procedural risk factors was also investigated. Results Twenty-three vascular complications occurred in the 299 patients in the study group (7.7%). There were no demographic risk factors associated with vascular complications and no statistical difference between use of closure device (ProGlide® vs MANTA®) and vascular complications. Vascular complications after TAVI were significantly associated with sheath size (OR 1.36, 95% CI 1.08–1.76, P 0.01) and strongly associated with necrotic core volume in the common femoral artery of the procedural side (OR 17.49, 95% CI 1.21–226.60, P 0.03). The use of the ProGlide® closure device (T 2.99, P 0.004) rather than MANTA® was significantly associated with an increased time to haemostasis after TAVI. Conclusion Plaque map analysis of plaque composition of the common femoral artery by CT angiography reveals patients with greater necrotic core are at increased risk of VARC vascular complications.