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Single Center Experience with Access-related Complications in Patients Undergoing Transcatheter Aortic Valve Replacement
Abstract   Peer reviewed

Single Center Experience with Access-related Complications in Patients Undergoing Transcatheter Aortic Valve Replacement

Mohamad Chahrour, Maen Aboul Hosn, Rachael Nicholson, Adeola Odugbesi, Arun Singhal, Nathalie Weger and Crystal Rodriguez
Journal of vascular surgery, Vol.80(3), pp.e83-e84
09/2024
DOI: 10.1016/j.jvs.2024.06.140

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Abstract

Objectives Despite introduction of valves requiring smaller sheath sizes, access-related complications are still encountered when performing transcatheter aortic valve replacement (TAVR). This study aims to describe our center's rates and types of complications, the role of vascular surgery in their management, and the possible risk factors for complications. Methods Patients undergoing TAVR between 2020 and 2024 were identified using our center's TAVR registry. Records of patients with vascular complications were retrospectively reviewed to collect data on comorbidities, access site, and treatment modalities. Results A total of 855 TAVR procedures were performed in our institution. The overall rate of access-related complications was 5.5% (n = 47; major access 4.9%, minor access 0.6%). For the major access, complications were at the femoral artery (98%) and axillary artery (2%). The accessed arteries were mildly diseased in 45% of patients and moderately/severely diseased in 26%. Extreme BMI (>30 or <20 kg/m2) was noted in 58% of patients with complications. The most common complication was dissection, followed by bleeding, stenosis/occlusion, and pseudoaneurysm (Fig). Management strategies included open surgery (45%), endovascular intervention (33%), combined procedure (7%), or conservative measures (15%). Vascular surgery was involved in 83% (n = 35) of cases, whereas the other 17% (n = 12) were managed by the cardiology and the cardiac surgery teams. Interventions performed are presented in Table. Three patients (6%) required reoperation after the initial vascular surgery procedure due to wound complications and limb ischemia. Conclusion With contemporary reported rates of access-related complications reaching up to 6%, TAVR programs should ensure the availability of vascular surgery support for management. Preoperative vascular surgery consultation for assistance with access in high-risk patients (eg, extreme BMI, diseased artery) should be considered.

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