Purpose:

Today in transfemoral Transcatheter Aortic Valve Implantation (TAVI) access is mostly gained percutaneously. Although the occurrence of access and bleeding complications is slowly declining, they still represent a highly relevant issue since the incidence remains high and access complications are associated with an increased mortality. Such access related vascular complications can be treated endovascularly including covered stenting or angioplasty, or surgically. The aim of this study was to  evaluate the short and long-term outcomes of  endovascular treatment  compared to surgical repair for access related vascular complications in transfemoral TAVI procedures.

Methods:

This retrospective study was conducted at the university hospital clinic of cologne from the January 1st, 2018, to December 31st, 2020. Included were all patients who suffered a surgical or endovascular treated access site complication during  transfemorally performed TAVI. Such patients were followed up by phone call in May and June 2022.

Results:

In total 1219 transfemoral TAVI procedures were conducted in the study period. 19 patients suffered an access complication requiring endovascular and 54 patients  required surgical repair. Patients treated endovascularly had a mean follow-up duration of 22.6 month and the surgical treated of 21.4 month (p= .767). No differences were found regarding the primary outcome re-operations (endovascular 15.8% vs. surgical 14.8%; p.=.919) after discharge. Also, we detected no differences regarding wound infections (endovascular 0% vs. surgical. 11.1%; p. = .129)  and wound healing disorders (endovascular 15.8% vs. surgical 29.6% ; p.=.237). Patients in whom vascular complications were treated  endovascularly were discharged faster (endovascular 11.2 vs. surgical 14.9 days p. = .028). After surgical repair patients received significantly more red blood cell transfusions (endovascular 1.00 vs. surgical 3.1 red blood cell concentrate bags; p.< .001).  No differences were found regarding clinical symptoms of peripheral arterial disease  during follow up.

Conclusion:

Endovascular treatment of access related vascular complications of transfemoral TAVI procedures is safe and feasible, led to less blood transfusions and a shorter hospitalization with similar clinical outcomes.