Computed tomography derived anatomical predictors of vascular access complications following transfemoral transcatheter aortic valve implantation: A systematic review

Abstract

BackgroundVascular complications after percutaneous transfemoral transcatheter aortic valve implantation (TAVI) are associated with adverse clinical outcomes and remain a significant challenge.AimsThe purpose of this review is to synthesize the existing evidence regarding the iliofemoral artery features predictive of vascular complications after TAVI on pre‐procedural contrast‐enhanced multidetector computed tomography (MDCT).MethodsA systematic search was performed in Embase and Medline (Pubmed) databases. Studies of patients undergoing transfemoral TAVI with MDCT were included. Studies with only valve‐in‐valve TAVI, planned surgical intervention and those using fluoroscopic assessment were excluded. Data on study cohort, procedural characteristics and significant predictors of vascular complications were extracted.ResultsWe identified 23 original studies involving 8697 patients who underwent TAVI between 2006 and 2020. Of all patients, 8514 (97.9%) underwent percutaneous transfemoral‐TAVI, of which 8068 (94.8%) had contrast‐enhanced MDCT. The incidence of major vascular complications was 6.7 ± 4.1% and minor vascular complications 26.1 ± 7.8%. Significant independent predictors of major and minor complications related to vessel dimensions were common femoral artery depth (>54 mm), sheath‐to‐iliofemoral artery diameter ratio (>0.91–1.19), sheath‐to‐femoral artery diameter ratio (>1.03–1.45) and sheath‐to‐femoral artery area ratio (>1.35). Substantial iliofemoral vessel tortuosity predicted 2–5‐fold higher vascular risk. Significant iliofemoral calcification predicted 2–5‐fold higher risk. The iliac morphology score was the only hybrid scoring system with predictive value.ConclusionsIndependent iliofemoral predictors of access‐site complications in TAVI were related to vessel size, depth, calcification and tortuosity. These should be considered when planning transfemoral TAVI and in the design of future risk prediction models.

Utility of Coronary Computed Tomography Angiography in Patients Undergoing Transcatheter Aortic Valve Implantation: A Meta-Analysis and Meta-Regression Based on Published Data from 7458 Patients

“…In selected patients, CT may also allow for the identification of bicuspid aortic valve disease, which may be associated with an abnormal morphology and may require different procedural strategies. Pre-TAVI CT assessment of the aorta, up to the level of the femoral artery distally, is essential for vascular access pathway assessment [14]. Additionally, CT angiography assesses the caliber, tortuosity, and calcification of potential access routes (transfemoral, transapical, or transaortic), enabling clinicians to determine the most suitable access pathway [9].…”