Long-term follow-up after stent graft placement for access-site and access-related vascular injury during TAVI – The Bonn-Copenhagen experience. (15th April 2019)

• Record Type: Journal Article
• Authors: Sedaghat, Alexander; Hansen, Kristoffer Lindskov; Schahab, Nadjib; May, Maria Cesarina; Weber, Marcel; Stundl, Anja; Shamekhi, Jasmin; Schaefer, Christian; Nickenig, Georg; Sinning, Jan-Malte; Lönn, Lars; Søndergaard, Lars; Werner, Nikos; De Backer, Ole
• Is Part Of: International journal of cardiology. Volume 281(2019)
• Page Start: 42
• Page End: 46
• Publication Date: 2019-04-15
• Subjects: ASARVI access-site and access-related vascular injury -- CFA common femoral artery -- CT computed tomography -- PFA profunda femoral artery -- PVR peak velocity ratio -- RBC red blood cell -- SFAR sheath-to-femoral-artery ratio -- TAVI transcatheter aortic valve implantation -- VARC-2 Valve Academic Research Consortium; TAVI -- Vascular complication -- Access site -- Covered stent graft; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2018.12.053
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Aims: Stent graft placement is a safe and effective treatment option for vascular complications in the context of transcatheter aortic valve implantation (TAVI). This study aimed to provide long-term angiological follow-up of stent grafts used for this indication. Methods and results: Seventy-one patients (64.8% female, log EuroScore 14.7 ± 6.8%) who had undergone TAVI between March 2010 and October 2015 with implantation of a Viabahn or Fluency stent graft to treat access-site or access-related vascular injury (ASARVI) were analyzed. Implantations were mostly due to access-site bleeding complications (83.1%) in the common femoral artery (97.1%). Follow-up was performed with duplex sonography in all patients after a median of 3.9 years after TAVI (interquartile range [IQR]: 895–1749 days). Ultrasound revealed tri- or biphasic flow patterns in 16.9% and 77.6%, respectively. Stent graft patency was 100% without signs of stent graft stenosis (mean peak velocity ratio 1.0 ± 0.2). Pseudo-aneurysms or endoleaks were diagnosed in 5.6% of patients. Additional fluoroscopic and/or computed tomography (CT)-imaging was available in 36.6% of patients and did not reveal any stent fracture. Conclusion: Self-expanding stent grafts provide excellent long-term function with few complications when implanted in the context of TAVI-related ASARVI. Highlights: Long-term data on stent grafts used in TAVI-related vascular complications is missing. In this study we analyzed seventy-one patients treated with two different stent grafts. After a median of 3.9 years, no stent stenosis or stent fracture was observed. Pseudo-aneurysms or endoleaks were observed in 5.6% of patients. Stent grafts provide a durable treatment for TAVI-related vascular complications.