Key result
Covered stents achieve ~97% technical success managing vascular access complications during TAVR.
Why the study?
Iliofemoral vascular access complications after transfemoral TAVR are common, and the long-term safety and efficacy of covered stents for managing these complications remain unclear.
Do covered stents safely and effectively manage vascular access complications in patients undergoing transfemoral TAVR?
Meta-Analysis
Do covered stents safely and effectively manage vascular access complications in patients undergoing transfemoral TAVR?
Covered stents provide a safe and effective short-term percutaneous management strategy for TAVR-associated vascular access complications, yielding high technical success and patency rates.
Supports covered stents for TAVR vascular complications; extends observational data but leaves open need for RCTs on durability.
Background Iliofemoral Vascular access complications (VACs) after transfemoral transcatheter aortic valve replacements (TAVR) are common, with reported rates of 10-20%. Historically, TAVR was intended for high-risk patients, making percutaneous management of VACs with covered stents appealing, though their long-term safety and efficacy remain unclear. This study aims to evaluate the safety and efficacy of covered stents for managing VACs after transfemoral TAVR. Methods We conducted a systematic review and meta-analysis of observational studies. Fourteen studies met eligibility criteria. Primary outcomes were technical success and primary patency. Secondary outcomes included stent-related complications, procedure-related complications, and survival. Results Short-term outcomes were favourable, with a pooled technical success rate of 96.92% and a pooled primary patency rate at 30 days of 99.78%. Pooled short-term survival was 97.18%. Pooled stent-related complications at 30 days were 1.00%, and procedure-related complications were 1.32%. Follow-up outcomes reported after 30 days were heterogeneous. Pooled 1-year survival across five studies was 79.32%. Median cumulative incidence of post-30-day stent-related complications was 1.72% (IQR 0 - 4.00%) across 11 studies. Pooled primary patency was 97.20% at 1 year across four studies. Conclusion Based on short-term outcomes, covered stents appear to be a safe and effective intervention for TAVR vascular access complications in the intermediate- to high-risk population, as demonstrated by high patency rates, technical success, and short- and post-30-day complication rates. The absence of comparative data, heterogeneous outcome reporting, and limited post-30-day follow-up imaging surveillance limit conclusions regarding long-term outcomes.
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Mahmoud et al. (2026) conducted a meta-analysis in Vascular access complications after transfemoral transcatheter aortic valve replacement. Covered stents was evaluated on Technical success and primary patency. Covered stents for managing TAVR vascular access complications demonstrated a pooled technical success rate of 96.92% and a 30-day primary patency rate of 99.78%.
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