Background: Transcatheter aortic valve implantation (TAVI) is a common treatment option for patients (pts) with symptomatic severe aortic stenosis (AS). Despite its proven effectiveness and decreasing complication rate, vascular access site complications still occur in 5–7% of the cases and are associated with increased mortality and morbidity. Calcification of the access site has been shown to be associated with vascular access site complication.

Purpose: To compare patients with vascular access site complication during TAVI who received either conventional or echo guided-puncture to better understand underlying mechanisms and aid future risk stratification.

Methods: From our ongoing single center TAVI registry encompassing 3969 patients, 1600 received a conventional puncture at the access site. From these 190 experienced a vascular complication. The remaining 2369 patients received an echo guided puncture, from these 191 experienced a vascular complication. 404 patients who underwent TAVI without vascular complication were randomly selected as a control group. In these patients as well in those with vascular complication we quantified calcification burden in the femoral artery with a localized, upward calcium scoring over 2,5 cm starting from the bifurcation. Measurements were conducted in all patients using the 3mensio structural heart software ver. 8.0 (Pie Medical Imaging BV). Comparison between groups was done using the t-test.

Results: Patients receiving an echo guided puncture had less vascular complications compared to those receiving a conventional puncture (8.6% vs. 12.1%, p = <0.001). Patients experiencing vascular complications were more often on oral anticoagulation (32.1% vs. 15.1%, p=<0.001), were slightly younger (82.1 vs. 83.2 years, p=0.015) and more often male (35.3% vs. 28,7%, p= 0.04). No differences between patients with and without complication were found in regard to EuroScore II (p=0.64), BMI (p=0.65) or known peripheral artery disease (p=0.26). The general calcium score was not significantly different between the conventional and echo-guided puncture groups (129.6 vs. 132.1 mm², p=0.88). However, degree of anterior calcification, which has been shown to be associated with access site complications, was significantly lower in patients receiving an echo-guided puncture compared to the conventional puncture group (16.7 vs. 25.6 mm², p= 0.038).