Key result
High vessel tortuosity index is linked to ~68% higher 6-month mortality in Tf-TAVI patients.
Why the study?
The peripheral vessel tortuosity index was proposed to discriminate procedural success in transcatheter endovascular aortic replacement but not studied in transfemoral TAVI patients.
Does a high peripheral vessel tortuosity index (>1.50) increase mortality in patients undergoing transfemoral transcatheter aortic valve implantation?
Observational (n=2,002)
No
Does a high peripheral vessel tortuosity index (>1.50) increase mortality in patients undergoing transfemoral transcatheter aortic valve implantation?
A peripheral vessel tortuosity index > 1.50 is independently associated with increased 6-month mortality in patients undergoing transfemoral TAVI, suggesting its utility for risk stratification.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“New from Munich (n=2,002 transfemoral TAVI): an iliac/femoral tortuosity index above 1.5 stayed independently linked to higher 6-month mortality (HR about 1.7), even when those patients weren't 'sicker' on the usual comorbidities. Diameter and calcium still matter. Geometry might too. It's worth a line on the CT checklist before large-bore access.”
High tortuosity index was associated with higher Tf-TAVI mortality; hypothesis-generating for risk stratification and requires prospective validation.
Background and aims The peripheral vessel tortuosity index (TI) was proposed to discriminate procedural success in patients undergoing transcatheter endovascular aortic replacement but not in those undergoing transcatheter aortic valve implantation (TAVI). We aimed to investigate the TI and its prognostic relevance in patients undergoing transfemoral (Tf) TAVI. Methods Retrospective, observational single-center study, including patients undergoing Tf-TAVI from April 2011 to January 2023 at the TUM University Hospital, German Heart Centre, and available computed tomography angiography (CTA). Peripheral vessel measurements were performed using dedicated software (3mensio, Pie Medical). TI was determined dividing true central lumen vessel length from centerline reconstruction and direct distance from the aorto-iliac bifurcation to the epigastric artery. TI was dichotomized based on severity according to EVAR guidelines, where a TI of 1.5 is considered discriminatory for nonsevere tortuosity [< 1.5 for low TI (LTI)] and > 1.5 for high TI (HTI)]. Valve Academic Research Consortium 3 definitions were applied to describe procedural and follow-up outcomes. Mortality at 6-month follow-up was evaluated. Results We included 2002 patients. Overall age was 81 years [77, 85], 45.2% were female, EuroScore II was 4.22 [2.39, 7.60]. Age ( p < 0.001), female sex ( p < 0.001), diabetes ( p < 0.001), peripheral artery disease ( p = 0.002), myocardial infarction ( p = 0.013), and creatinine ( p = 0.001) were associated with tortuosity. Adjusted 6-month analysis showed that TI > 1.50 was associated with increased mortality [hazard ratio (HR) 1.679, 95% CI (1.098–2.567), p = 0.017]. Conclusions TI > 1.50 may determine a higher-risk population in patients undergoing Tf-TAVI. Further study is required to validate our findings. Graphical abstract Tortuosity index as a risk factor for mortality at 6 months after transcatheter aortic valve implantation.
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Alvarez‐Covarrubias et al. (2026) conducted an observational in Aortic stenosis requiring transfemoral transcatheter aortic valve implantation (Tf-TAVI) (n=2,002). High peripheral vessel tortuosity index (TI > 1.50) vs. Low peripheral vessel tortuosity index (TI ≤ 1.50) was evaluated on Mortality at 6-month follow-up (HR 1.679, 95% CI 1.098-2.567, p=0.017). A high peripheral vessel tortuosity index (>1.50) was associated with a significantly increased risk of 6-month mortality (HR 1.679) compared to a low tortuosity index in patients undergoing Tf-TAVI.
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