Incidence, predictors, impact, and treatment of vascular complications after transcatheter aortic valve implantation in a modern prospective cohort under real conditions

Abstract

Article highlightsType of research: Multicenter, prospective, nonrandomized cohort study Key findings: The incidence of vascular complications was high (26.1%) following 479 transcatheter aortic valve implantation (TAVI), but 88.8% were minor and survival was not affected. Major complications were rare. they were treated with surgery and had a significant impact on survival at 30 days (69.3%) and 1 year (59.4%) .

The Iliofemoral tortuosity score predicts access and bleeding complications during transfemoral transcatheter aortic valve replacement: Data from the VIenna Cardio Thoracic aOrtic valve registrY (VICTORY)

“…10 Although it has been suggested that moderate-severe tortuosity is predictive of vascular complications, when patients have been classified according to their maximum LSA in a study by Hammer et al, no significant difference in vascular complications was found between them. 11,12 One of the pitfalls of the LSA is that its value can be high in vasculature with short yet deep indentations, which may be easily traversed. Moreover, the LSA does not consider the frequency of kinks in the iliofemoral system, which may cause the procedure to become technically challenging.…”

“…Similarly, Kinnel et al found that even when tortuosity was classified as an LSA > 90°, its prevalence was not significantly different between patients who reached an early safety composite endpoint and those who did not 10 . Although it has been suggested that moderate‐severe tortuosity is predictive of vascular complications, when patients have been classified according to their maximum LSA in a study by Hammer et al, no significant difference in vascular complications was found between them 11,12 . One of the pitfalls of the LSA is that its value can be high in vasculature with short yet deep indentations, which may be easily traversed.…”

“…8 Qualifying the degree of tortuosity based on the largest angle present within the arteries used for access in TF-TAVR has had limited success at both predicting or delineating patients who subsequently suffer from major vascular complications. [9][10][11][12] An alternative approach to expressing tortuosity has been to add up the different angulations at various points in a vessel and express this as a ratio relative to the access vessel diameter. While this method has shown promise as an indicator for patients more likely to suffer from major vascular complications, the data fuelling these initial findings were primarily based on single plane angiography, rather than more accurate computed tomography scans.…”

“…Despite the correlation between higher tortuosity of the iliofemoral vessels and a higher risk for access complications during transfemoral‐TAVR (TF‐TAVR) seeming implicit, no three‐dimensional assessment method of vascular tortuosity is currently available for preprocedural risk stratification 8 . Qualifying the degree of tortuosity based on the largest angle present within the arteries used for access in TF‐TAVR has had limited success at both predicting or delineating patients who subsequently suffer from major vascular complications 9‐12 . An alternative approach to expressing tortuosity has been to add up the different angulations at various points in a vessel and express this as a ratio relative to the access vessel diameter.…”

Incidence and Risk Assessment of Infolding Using Self-Expandable Devices in TAVR

“…Peripheral kinking was defined as pronounced S-form tortuosity of the aorto-iliac and femoral arteries. 7 Resheath/recapture was defined as partial retrieval of the delivered valve/complete retrieval with the intention to recross the valve. 8 INF was defined as persisting wrinkling along the stent frame resulting in an all-over invagination of the inflow and outflow tract (in contrast to only malexpansion, i.e., distortion of only the inflow tract).…”