Key result
Routine post-closure transradial angiography after TAVR shows a ~0.4% rate of major vascular complications.
Why the study?
Vascular complications after transfemoral TAVR increase morbidity and mortality, making measures to mitigate this risk important.
Does routine postaccess-closure angiography detect vascular complications and mitigate risk in patients undergoing transfemoral TAVR?
Cohort (n=512)
No
Does routine postaccess-closure angiography detect vascular complications and mitigate risk in patients undergoing transfemoral TAVR?
Routine post-closure angiography via the radial artery is a safe and feasible practice that facilitates the early detection and management of vascular complications following transfemoral TAVR.
Supports feasibility of routine radial post-closure angiography after TAVR; leaves open whether it reduces complications versus selective imaging.
BACKGROUND: Vascular complications following transfemoral TAVR are associated with increased morbidity and mortality. Measures that may mitigate this risk are important. AIM: To evaluate the utility of routine, access-vessel angiography post sheath-removal in the detection and management of complications in patients undergoing transcatheter aortic valve replacement (TAVR). METHODS: This was a retrospective study of 512 consecutive patients who underwent transfemoral TAVR with routine post access-closure angiography from the radial artery. Rates of mild angiographically evident bleeding, bleeding requiring surgery/interventional-radiology, ischemia, 90-day access-site-related events, and major and minor vascular complications using Valve Academic Research Consortium 3 definitions were recorded. RESULTS: Of 512 patients, digital subtraction angiography (DSA) was undertaken via the radial artery in 467 patients (91%). In the remaining patients (9%) DSA was either not attempted, due to concerns regarding kidney disease and contrast volume, or failed due to anatomical factors (aortic tortuosity/calcification). Significant chronic kidney disease was present at baseline in 72.4% of this cohort (stages III-IV or dialysis). Ninety-four percent of cases underwent TAVR using a balloon-expandable platform. Mild iliofemoral extravasation was observed in 7.7% of the DSA cases. These cases were managed by manual compression with none requiring any vascular intervention subsequently. Valve Academic Research Consortium 3 major and minor access-site-related complications were observed in 0.4% and 12.2%, respectively. Access-site-related bleeding and ischemic events requiring interventional-radiology or vascular-surgery were observed in 0.9% and 1.7% of the DSA cases, respectively. No new renal replacement therapy was needed in any of the DSA cases. Discharge to 90-day access-related complications was 0.8%. CONCLUSIONS: Routine post access-closure angiography is feasible via the radial artery in patients undergoing transfemoral TAVR and appears safe. It facilitates early identification of complications and mitigates risk by enabling prompt action to be taken. Larger studies are needed to confirm these findings.
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Savvoulidis et al. (2023) conducted a cohort in Transfemoral transcatheter aortic valve replacement (TAVR) (n=512). Routine post access-closure digital subtraction angiography was evaluated on VARC-3 major access-site-related complications. Routine postaccess-closure angiography via the radial artery after transfemoral TAVR is feasible, with VARC-3 major and minor vascular complications observed in 0.4% and 12.2% of patients, respectively.
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