Key result
Ultrasound-guided access in transfemoral TAVI linked to ~49% fewer vascular and bleeding complications vs fluoroscopy.
Why the study?
Both angiography roadmap and ultrasound are commonly used to obtain femoral access during transfemoral TAVI, but the effect of implementing ultrasound guidance on vascular and bleeding complications needed evaluation.
Does ultrasound-guided femoral access reduce vascular and bleeding complications compared to angiographic roadmap guidance in patients undergoing transfemoral TAVI?
Cohort (n=1,026)
No
Does ultrasound-guided femoral access reduce vascular and bleeding complications compared to angiographic roadmap guidance in patients undergoing transfemoral TAVI?
Odds Ratio: 0.51 (95% CI 0.33–0.77)
Absolute Event Rate: 8.3% vs 16.1%
p-value: p=0.002
Routine ultrasound guidance for femoral arterial access during transfemoral TAVI significantly reduces vascular and bleeding complications compared to angiographic roadmap guidance, even among highly experienced operators.
May support ultrasound-guided femoral access in TAVI; leaves open need for randomized confirmation.
Background Both angiography roadmap (RM) and ultrasound (US) are commonly used to obtain femoral arterial access during transfemoral transcatheter aortic valve implantation (TAVI). In this analysis, we sought to evaluate the effect of implementation of an US-guided approach on vascular and bleeding complications. Methods Vascular complications and bleeding at the main access site were compared using 4-year data from two experienced TAVI-operators, who changed their practice from an exclusively RM- to an exclusively US-guided technique for access in transfemoral TAVI. Results A total of 1026 patients were analyzed (RM: n = 485, US: n = 541) with a mean age of 80.7 ± 6.3 years; 47.7% were female and 37.1% received a balloon-expandable valve. Main access vascular complications, bleedings, or their composite were lower in the US-group (RM vs. US: 16.1% vs. 8.3%, p < 0.001). US was a protective factor for vascular complications, bleeding and their composite (adjusted odds ratio [OR] 0.51, 95%-confidence interval [CI] 0.33–0.77, p = 0.002; adjusted OR 0.46, 95%-CI 0.28–0.78, p = 0.003; and adjusted OR: 0.47; 95% CI 0.32–0.70, p < 0.001, respectively). Fluoroscopy time (14 [interquartile range (IQR) 11 – 20] min vs. 13 [IQR 10 – 17] min, p < 0.001), contrast use (88 [IQR 69 – 111] ml vs. 84 [IQR 65 – 110] ml, p = 0.049) and procedure time (52 [IQR 44 – 67] min vs. 49 [IQR 41 – 62] min, p = 0.02) were lower in the US-group. Conclusions US-guided femoral access was associated with significantly fewer complications compared with RM-guidance, supporting its adoption even among operators experienced with angiographic guidance. Graphical Abstract Central illustration (Top) Visual representation of the design of the study with examples of the used techniques: (Top left) RM and (Top right) US. (Bottom) Rates of the combined primary endpoint of vascular complications and bleedings at the main access site (middle), main access vascular complications (left) and procedural characteristics (right). RM = Angiographic Roadmap; US = Ultrasound, VARC-3 = Valve Academic Research Consortium 3
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Lankisch et al. (2025) conducted a cohort in Transfemoral transcatheter aortic valve implantation (TAVI) (n=1,026). Ultrasound-guided femoral access vs. Angiographic roadmap (RM) guided access was evaluated on Composite of vascular complications and bleeding events at the main access site (VARC-3 criteria) (adjusted OR 0.51, 95% CI 0.33-0.77, p=0.002). Ultrasound-guided femoral access during transfemoral TAVI significantly reduced the composite of main access vascular and bleeding complications compared to angiographic roadmap guidance (adjusted OR 0.51).
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