What question did this study set out to answer?

Investigate the incidence and predictive risk factors of femoral vascular complications using postinterventional ultrasound following transfemoral transcatheter aortic valve replacement.

December 9, 2023Clinical CardiologyOpen Access

Femoral vessel complications after transfemoral TAVR—A contemporary sonography‐based assessment of 480 patients with third‐generation transcatheter valves

View Full Paper

Ask AI

Bookmark

Why the study?

Postinterventional sonographic assessment after TF-TAVR can identify femoral artery pathologies, prompting investigation into the incidence and risk factors of femoral vessel complications in a modern cohort.

What is the incidence and what are the risk factors for femoral vessel complications assessed by sonography after transfemoral TAVR?

Key Points

Investigate the incidence and predictive risk factors of femoral vascular complications using postinterventional ultrasound following transfemoral transcatheter aortic valve replacement.
Analyzed 480 patients undergoing transfemoral transcatheter aortic valve replacement (TF-TAVR) with postinterventional femoral sonography at a single center between September 2017 and March 2022.
Evaluated clinical adverse events according to Valve Academic Research Consortium 3 (VARC-3) criteria and identified risk factors via multivariable logistic regression.
Vascular complications occurred in 29.16% (n = 140) of patients, consisting of minor complications in 23.3% (n = 112) and major complications in 5.8% (n = 28).
Postinterventional femoral artery stenosis at the primary valve-delivery access site occurred in 9.8% (n = 47) of patients.
Independent predictors of femoral artery stenosis included female sex (OR 2.32, 95% CI 1.09–4.89, p = .03) and the number of endovascular closure devices used (OR 0.11, 95% CI 0.02–0.64, p = .014).

Structured PICO

What is the incidence and what are the risk factors for femoral vessel complications assessed by sonography after transfemoral TAVR?

Population

480 patients undergoing transfemoral transcatheter aortic valve replacement (TF-TAVR) at a single center, 51.2% male, mean age 80 ± 7.5 years, median EuroSCORE II 3.7.

Intervention

Transfemoral transcatheter aortic valve replacement (TF-TAVR) followed by postinterventional femoral sonography

Outcome

Incidence and risk factors of femoral vessel complications assessed by postinterventional sonography according to VARC-3 criteriasafety

Postinterventional sonography reveals a higher than expected incidence of femoral artery stenosis (9.8%) after TF-TAVR, with female sex and number of closure devices as independent risk factors.

Implication

Post-TF-TAVR femoral sonography may identify complications; leaves open whether routine use improves outcomes or warrants protocol changes.

Abstract

BACKGROUND: Postinterventional sonographic assessment of the femoral artery after transfemoral transcatheter aortic valve replacement (TF-TAVR) has the potential to identify several pathologies. We investigated the incidence and risk factors of femoral vessel complications in a modern TAVR collective using postinterventional sonography. METHODS: Between September 2017 and March 2022, 480 patients underwent TF-TAVR with postinterventional femoral sonography at a single center. Clinical outcomes and adverse events were analyzed after the Valve Academic Research Consortium 3 (VARC-3) criteria. RESULTS: In this cohort (51.2% male; age 80 ± 7.5 years, median EuroSCORE II 3.7) 74.8% (n = 359) were implanted with a self-expandable and 25.2% (n = 121) with a balloon-expandable valve. The main access (valve-delivery) was located right in 91.4% (n = 438), and the primary closure system was Proglide in 95% (n = 456). Vascular complications (VC) were observed in 29.16% (n = 140) of patients; 23.3% (n = 112) presented with minor- and 5.8% (n = 28) with major VC. Postinterventional femoral artery stenosis on the main access was observed in 9.8% (n = 47). Multivariable logistic regression analysis revealed female sex (p = .03, odds ratio [OR] 2.32, 95% confidence interval [CI] 1.09-4.89) and the number of used endovascular closure devices (p = .014, OR 0.11, 95%CI 0.02-0.64) as predictive factors for femoral artery stenosis. CONCLUSIONS: The incidence of postinterventional femoral artery stenosis following TF-TAVR was higher than expected with a number of used closure devices and female sex being independent risk factors. Considering the continuous advance of TAVR in low-risk patients with preserved physical activity, emphasis should be directed at the correct diagnosis and follow-up of these complications.