Vascular Access in Patients With Peripheral Arterial Disease Undergoing TAVR

Palmerini, Tullio; Saia, Francesco; Kim, Won-Keun; Renker, Matthias; Iadanza, Alessandro; Fineschi, Massimo; Bruno, Antonio Giulio; Ghetti, Gabriele; Vanhaverbeke, Maarten; Søndergaard, Lars; Romagnoli, Enrico; Burzotta, Francesco; Trani, Carlo; Adrichem, Rik; Mieghem, Nicolas Van; Nardi, Elena; Fraccaro, Chiara; Orzalkiewicz, Mateusz; Tomii, Daijiro; Pilgrim, Thomas; Aranzulla, Tiziana Claudia; Musumeci, Giuseppe; Adam, Matti; Meertens, Max; Taglieri, Nevio; Marrozzini, Cinzia; Covarrubias, Héctor Alfonso Alvarez; Nardi, Giulia; Muro, Francesca Maria Di; Mario, Carlo Di; Loretz, Lucca; Toggweiler, Stefan; Gallitto, Enrico; Gargiulo, Mauro; Testa, Luca; Bedogni, Francesco; Berti, Sérgio; Ancona, Marco; Montorfano, Matteo; Leone, Alessandro; Savini, Carlo; Pacini, Davide; Gmeiner, Jonas; Braun, Daniel; Nerla, Roberto; Castriota, Fausto; Carlo, Marco De; Petronio, Anna Sonia; Barbanti, Marco; Costa, Giuliano; Tamburino, Corrado; Reimers, Bernhard; Stefanini, Giulio; Sudo, Mitsumasa; Nickenig, Georg; Piva, Tommaso; Scotti, Andrea; Latib, Azeem; Vercellino, Matteo; Porto, Italo; Codner, Pablo; Kornowski, Ran; Bartorelli, Antonio L.; Tarantini, Giuseppe; Chietera, Francesco; Abdel‐Wahab, Mohamed; Grube, Eberhard; Galiè, Nazzareno; Stone, Gregg W.

doi:10.1016/j.jcin.2022.12.009

Cited by 17 publications

(10 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Since the decline of transapical access in recent years, TAX has become the main alternative access strategy in most centers. Despite benefits over other alternative access strategies, an elevated periprocedural risk compared to TF has been shown, in particular regarding periprocedural strokes [ 2 , 22 , 23 ]. Pushing the TF route with IVL assistance may hence be a valid option in patients with hostile iliofemoral anatomies.…”

Section: Discussionmentioning

confidence: 99%

Intravascular Lithotripsy-Assisted Transfemoral Transcatheter Aortic Valve Implantation in Patients with Severe Iliofemoral Calcifications: Expanding Transfemoral Indications

Linder,

Grundmann,

Kellner

et al. 2024

JCM

View full text Add to dashboard Cite

(1) Background: Transfemoral transcatheter aortic valve implantation (TAVI) has become the standard treatment for most patients with severe symptomatic aortic stenosis. Intravascular lithotripsy may facilitate transfemoral TAVI (IVL-TAVI) even in patients with severely calcified iliofemoral disease. We assessed technical aspects and clinical outcomes of this novel approach compared to alternative transaxillary access (TAX-TAVI). (2) Methods: IVL-TAVI was performed for severe iliofemoral calcifications precluding standard transfemoral access in 30 patients from 2019 to 2022 at a single academic heart center. IVL was performed as part of the TAVI procedure in all cases. Results were compared to a control group of 44 TAX-TAVI procedures performed for the same indication from 2016 to 2021. The safety outcome was a composite of all-cause death, stroke, access-related bleeding ≥ type 2 within 24 h and major vascular access site complications at 30 days. The efficacy outcome was defined as a technical success according to VARC-3. (3) Results: Median age was 78.2 [74.3, 82.6] years, 45.9% were female and mean STS-PROM was 3.6% [2.3, 6.0]. Iliofemoral calcifications were more severe in the IVL-TAVI vs. TAX-TAVI groups (lesion length: 63.0 mm [48.6, 80.3] vs. 48.5 mm [33.1, 68.8]; p = 0.043, severe calcification at target lesion: 90.0% vs. 68.2%; p = 0.047, and median arc calcification 360.0° [297.5, 360.0] vs. 360.0° [180.0, 360.0]; p = 0.033). Technical success was achieved in 93.3% vs. 81.8% (p = 0.187) in IVL- and TAX-TAVI and the safety outcome occurred in 10.0% vs. 31.8% in IVL- and TAX-TAVI (p = 0.047), respectively. (4) Conclusions: IVL-assisted transfemoral TAVI was feasible and safe with favorable outcomes compared to TAX-TAVI. IVL may further expand the number of patients eligible for transfemoral TAVI and may help overcome limitations of an alternative access.

show abstract

Section: Discussionmentioning

confidence: 99%

Intravascular Lithotripsy-Assisted Transfemoral Transcatheter Aortic Valve Implantation in Patients with Severe Iliofemoral Calcifications: Expanding Transfemoral Indications

Linder,

Grundmann,

Kellner

et al. 2024

JCM

View full text Add to dashboard Cite

show abstract

“…However, transapical access has been associated with higher mortality. [24][25][26] Patients with PVD with involvement of the peripheral VB present a unique challenge for vascular access driven by vascular anatomy, calcifications, or history of peripheral vascular interventions. These factors also drive major vascular and bleeding complications, which were more common in patients with versus without PVD.…”

Section: Discussionmentioning

confidence: 99%

“…27 The Hostile Registry demonstrated lower rates of 30-day all-cause mortality, TIA/stroke, major bleeding, major vascular complications, and 1-year mortality in patients with PAD who underwent peripheral vascular intervention before transfemoral access compared with those who underwent transthoracic and nonthoracic alternative access, making it a viable option in this vulnerable population. 26 Recently, transcaval access has also emerged as an alternative option for nonfemoral access. 28 In patients with PVD, the decision on the choice of TAVR access should be made in a multidisciplinary heart team approach taking into account local expertise and experience with peripheral vascular intervention and alternate access to achieve the best outcomes.…”

Section: Discussionmentioning

confidence: 99%

Association Between Polyvascular Disease and Transcatheter Aortic Valve Replacement Outcomes: Insights From the STS/ACC TVT Registry

Bansal,

Soni,

Shah

et al. 2023

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

Background: Atherosclerotic cardiovascular disease (ASCVD) is highly prevalent in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). Polyvascular disease (PVD), defined as involvement of ≥2 vascular beds (VB) i.e., coronary, cerebrovascular, or peripheral, portends a poor prognosis in patients with ASCVD; however, data on the association of PVD with outcomes of patients undergoing TAVR are limited. Methods: The Society of Thoracic Surgeons and the American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) Registry was analyzed to identify patients who underwent TAVR from November 2011 through March 2022. Exposure of interest was PVD. Primary outcome was all-cause mortality. Secondary outcomes included major vascular complications, major/life-threatening bleeding, myocardial infarction (MI), transient ischemic attack (TIA)/stroke, and valve and non-valve related readmissions. Outcomes were assessed at 30 days and 1 year. Results: Of 443,790 patients who underwent TAVR, PVD was present in 150,823 (34.0%) [111,425 (25.1%) with 2VB-PVD and 39,398 (8.9%) with 3VB-PVD]. On multivariable analysis, PVD was associated with increased all-cause mortality at 1 year (hazard ratio [HR] 1.17; 95% CI, 1.14-1.20). There was an incremental increase in 1-year mortality with increasing number of VB involved (no PVD [ref.], 2VB-PVD, HR 1.12; 95% CI, 1.09-1.15, and 3VB-PVD, HR 1.31; 95% CI, 1.26-1.36). Patients with vs. without PVD had higher rates of major vascular complications, major/life-threatening bleeding, TIA/stroke, and non-valve related readmissions at 30 days and 1 year. Conclusions: PVD is associated with worse outcomes after TAVR, and the risk is highest in patients with 3VB-PVD.

show abstract

“…In the Hostile registry, Palmerini et al compared transfemoral access after percutaneous preparation (i.e., with lithotripsy) and transthoracic or nontransthoracic (mainly axillary) alternative access. 6 Mortality rates were lower for both transfemoral and nontransthoracic alternative access, but stroke rates were higher in the latter. More recently, TC access has gained increasing interest.…”

Section: The Transaxillary Approach Should Be the First Choice For Al...mentioning

confidence: 94%

“…In those patients with inaccessible femoral arteries, alternative access routes have been described. 6 The alternative access routes can be divided into thoracic access routes (i.e., transapical or direct transaortic access) and peripheral alternative access routes (i.e., transaxillary, transsubcubclavian, transcarotid [TC], or transcaval access). The most frequently used alternative peripheral access is the transaxillary approach.…”

Section: Introductionmentioning

confidence: 99%