Key result
Adverse iliofemoral CT anatomy linked to up to ~5-fold higher vascular complications in transfemoral TAVI.
Why the study?
Vascular complications after percutaneous transfemoral TAVI are associated with adverse outcomes and remain a challenge, prompting a synthesis of pre-procedural contrast-enhanced MDCT iliofemoral predictors.
What are the MDCT-derived anatomical predictors of vascular access complications following transfemoral TAVI?
Systematic Review (n=8,697)
What are the MDCT-derived anatomical predictors of vascular access complications following transfemoral TAVI?
Pre-procedural MDCT assessment of iliofemoral vessel size, depth, calcification, and tortuosity identifies patients at high risk for vascular access complications during transfemoral TAVI.
Integrate MDCT iliofemoral assessment into transfemoral TAVI planning; confirms independent prediction of vascular complications by tortuosity and calcification.
BACKGROUND: Vascular complications after percutaneous transfemoral transcatheter aortic valve implantation (TAVI) are associated with adverse clinical outcomes and remain a significant challenge. AIMS: The purpose of this review is to synthesize the existing evidence regarding the iliofemoral artery features predictive of vascular complications after TAVI on pre-procedural contrast-enhanced multidetector computed tomography (MDCT). METHODS: A systematic search was performed in Embase and Medline (Pubmed) databases. Studies of patients undergoing transfemoral TAVI with MDCT were included. Studies with only valve-in-valve TAVI, planned surgical intervention and those using fluoroscopic assessment were excluded. Data on study cohort, procedural characteristics and significant predictors of vascular complications were extracted. RESULTS: We identified 23 original studies involving 8697 patients who underwent TAVI between 2006 and 2020. Of all patients, 8514 (97.9%) underwent percutaneous transfemoral-TAVI, of which 8068 (94.8%) had contrast-enhanced MDCT. The incidence of major vascular complications was 6.7 ± 4.1% and minor vascular complications 26.1 ± 7.8%. Significant independent predictors of major and minor complications related to vessel dimensions were common femoral artery depth (>54 mm), sheath-to-iliofemoral artery diameter ratio (>0.91-1.19), sheath-to-femoral artery diameter ratio (>1.03-1.45) and sheath-to-femoral artery area ratio (>1.35). Substantial iliofemoral vessel tortuosity predicted 2-5-fold higher vascular risk. Significant iliofemoral calcification predicted 2-5-fold higher risk. The iliac morphology score was the only hybrid scoring system with predictive value. CONCLUSIONS: Independent iliofemoral predictors of access-site complications in TAVI were related to vessel size, depth, calcification and tortuosity. These should be considered when planning transfemoral TAVI and in the design of future risk prediction models.
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Androshchuk et al. (2023) conducted a systematic review in Transfemoral transcatheter aortic valve implantation (TAVI) (n=8,697). Adverse iliofemoral artery features on MDCT vs. Favorable iliofemoral artery features was evaluated on Major and minor vascular complications. Adverse iliofemoral features on pre-procedural MDCT, including substantial tortuosity and significant calcification, independently predicted a 2- to 5-fold higher risk of vascular complications after transfemoral TAVI.
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