Long-Term Outcome of Covered Stent Implantation for Management of Iliofemoral Vascular Complications in Patients Undergoing Transcatheter Aortic Valve Replacement

Background: Covered stent implantation has become a common approach for management of iliofemoral vascular complications in patients undergoing transcatheter aortic valve replacement (TAVR), but the long-term outcomes associated with this approach are unknown. The aims of the study were 1) to evaluate the incidence and indication for covered stent placement in patients undergoing TAVR, 2) to assess long-term clinical outcomes after covered stent placement, and 3) to describe the performance of covered stents over long-term follow-up as assessed by Doppler ultrasonography. Methods: Retrospective cohort study of patients undergoing iliofemoral covered stent implantation at the time of TAVR in a single high-volume UK center. Results: 1277 patients underwent transfemoral TAVR between January 1, 2019, and December 31, 2022. Of these, a total of 54 patients (4.2%) underwent iliofemoral covered stent implantation. Indications for covered stent placement were hemorrhage (39/54, 72.2%), dissection (11/54, 20.4%), and other causes (4/54, 7.4%). Overall, the median follow-up time was 22 ​± ​2.3 months during which no patient required vascular reintervention on the stented limb. Doppler ultrasonography was performed on 27 (71%) of surviving patients at a median of 34 ​± ​2.6 months post-TAVR. There were no cases of stent fracture or complete occlusion. Two patients (7.4%) had evidence of asymptomatic moderate restenosis. Conclusion: Iliofemoral covered stent placement is a safe and effective means of managing significant vascular complications. Over long-term follow-up, we found no evidence of clinical stent failure requiring reintervention, and a low incidence of subclinical in-stent restenosis.