Routine Endovascular Treatment With a Stent Graft for Access-Site and Access-Related Vascular Injury in Transfemoral Transcatheter Aortic Valve Implantation

Sedaghat, Alexander; Neumann, Nils; Schahab, Nadjib; Sinning, Jan‐Malte; Hammerstingl, Christoph; Pingel, Simon; Schaefer, Christian; Mellert, Fritz; Schiller, Wolfgang; Welz, Armin; Grube, Eberhard; Nickenig, Georg; Werner, Nikos

doi:10.1161/circinterventions.116.003834

Cited by 33 publications

(31 citation statements)

References 31 publications

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“…Retroperitoneal haemorrhage is the most severe form of access site bleeding, which is clinically associated with increased mortality [8]. In a recent study, Sedaghat et al showed that implantation of a self-expanding nitinol stent graft in patients with vascular injuries (mainly bleeding) following transcatheter aortic valve replacement (TAVI) was a feasible and safe treatment and was associated with favourable short-and mid-term clinical outcomes [9,10]. In our patients…”

Section: Haemorrhagementioning

confidence: 56%

Endovascular management of femoral access-site and access-related vascular complications following percutaneous coronary interventions (PCI)

et al. 2020

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Background Major vascular complications (VCs) of ilio-femoral arterial access after percutaneous coronary interventions are infrequent, but are associated with increased mortality and morbidity. Routine endovascular repair of VCs is becoming the treatment of choice, especially for patients who cannot tolerate vascular surgery due to advanced cardiovascular disease or are in a bailout situation. Here, we review the different types of vascular access site complications associated with percutaneous coronary interventions (PCIs) and assess the safety and efficacy of endovascular treatment. Methods Data were retrospectively analysed from patients who experienced VCs after transfemoral PCIs, from December 2014 to May 2018. During this period, out of 2833 patients who underwent femoral coronary interventions, 53 (1.9%) experienced major VCs.

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Section: Haemorrhagementioning

confidence: 56%

Endovascular management of femoral access-site and access-related vascular complications following percutaneous coronary interventions (PCI)

et al. 2020

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“…In 407 TRANSFEMORAL‐TAVRs, 110 patients experienced access site vascular injury and 96 were treated with self‐expanding nitinol stents (mostly for minor complications such as bleeding and dissection). Angiography performed at 1‐year revealed one patient with moderate, asymptomatic in‐stent restenosis.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter aortic valve replacement: The year in review 2016

Harjai

Grines

Paradis

et al. 2017

J Interven Cardiology

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Transcatheter aortic valve replacement (TAVR) continued to make major strides in 2016, simultaneously expanding its application to lower risk patients as well as more technically challenging subsets of patients with aortic stenosis (AS). The two major accomplishments this year were the establishment of TAVR as the preferred treatment strategy over surgical aortic valve replacement (SAVR) in intermediate risk patients, and initial signals that TAVR and SAVR may be clinically equivalent in low-risk populations. Meanwhile, there is continued expansion of TAVR to challenging clinical subsets (bicuspid aortic valve [BAV], patients with concomitant advanced coronary artery disease [CAD], and failed surgical bioprostheses), and encouraging initial experiences with newer transcatheter heart valve systems. This paper summarizes the major research studies published on TAVR in 2016.

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“…During TAVR, a stented transcatheter heart valve prosthesis (THV) is delivered via catheter through the vascular system and deployed in the aortic annulus to replace the native aortic valve 2 . Despite the manifold benefits of this minimally invasive approach, certain complications arose with the advent of TAVR, such as THV migration/dislocation, 3 paravalvular leakage, 4 vascular complications, 5 and coronary obstruction 6 . Latter is a rare (<1%), but life‐threatening complication 7 .…”

Section: Introductionmentioning

confidence: 99%

“…complications, 5 and coronary obstruction. 6 Latter is a rare (<1%), but life-threatening complication.…”

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confidence: 99%

Hemodynamics inside the neo‐ and native sinus after TAVR: Effects of implant depth and cardiac output on flow field and coronary flow

Pott

Sedaghat²,

Schmitz

et al. 2020

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Abstr act Transcatheter aortic valve replacement (TAVR) has emerged as a widely used therapy for aortic valve diseases. With TAVR, flow hemodynamics may change leading to areas of flow stagnation prone to thrombosis risk. The neo‐sinus, created by introducing a prosthesis inside the diseased native valve, may prompt leaflet thrombosis due to areas of flow stasis. This study attempted to understand the effect of different prosthesis implant depths on the flow field within the neo‐ and native sinus and on the coronary perfusion. Experiments were performed inside an in vitro pulse duplicator producing physiological conditions according to ISO 5840‐1:2015 standard. Flow fields were obtained for two cardiac outputs (CO) using particle image velocimetry (PIV). Washout was calculated as a measure of flow stasis. The two main results are: a lower implant position and a lower CO/frequency led to better native sinus washout, but worsened neo‐sinus washout. In contrast, a higher implant position led to higher coronary flow (for higher CO/frequency). No significant effect of implant depth on coronary flow was observed for lower CO/frequency. In summary, a higher implant position using this self‐expanding prosthesis is associated with reduced neo‐sinus flow stasis. Hereby, washout of the native sinus, as well as coronary flow, are dependent on cardiac output.

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Routine Endovascular Treatment With a Stent Graft for Access-Site and Access-Related Vascular Injury in Transfemoral Transcatheter Aortic Valve Implantation

Cited by 33 publications

References 31 publications

Endovascular management of femoral access-site and access-related vascular complications following percutaneous coronary interventions (PCI)

Endovascular management of femoral access-site and access-related vascular complications following percutaneous coronary interventions (PCI)

Transcatheter aortic valve replacement: The year in review 2016

Hemodynamics inside the neo‐ and native sinus after TAVR: Effects of implant depth and cardiac output on flow field and coronary flow

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