Transcatheter aortic valve implantation-related vascular access complications: Are balloon-expandable stent grafts a good option?

IF 2.2 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases Pub Date : 2026-05-01 Epub Date: 2025-11-20 DOI:10.1016/j.acvd.2025.10.329

Gabriel Saiydoun , Romain Gallet , Saadé Saadé , Madjid Boukantar , Camille Brasselet , Paul-Mathieu Chiaroni , Costin Radu , Nicolas Lellouche , Ziyad Gunga , Thierry Folliguet , Emmanuel Teiger

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引用次数: 0

Abstract

Background

Among the most challenging complications of transfemoral transcatheter aortic valve implantation (TF-TAVI) are vascular access complications (VACs), with access-site bleeding frequently impacting outcomes despite preclosing techniques. Endovascular bailout strategies have become increasingly common despite historical concerns about stent placement in flexing zones.

Aims

To evaluate the efficacy and safety of balloon-expandable stent graft (BESG) implantation for VACs in patients undergoing TF-TAVI with a preclosure device.

Methods

This retrospective single-centre study included all consecutive patients who underwent TF-TAVI between January 2010 and December 2020. BESG implantation was used for persistent femoral bleeding following closure failure. Baseline, procedural and clinical data were compared between BESG recipients and controls in accordance with Valve Academic Research Consortium 3 (VARC-3) criteria.

Results

Among 1248 patients (mean ± standard deviation age 83.1 ± 7.3 years; 52.3% female), 225 (18.0%) had persistent femoral bleeding, and 98 (7.8%) required BESG implantation. Compared with controls, patients with BESG had larger sheath sizes (e.g. size 18 Fr: 73.5% vs 47.8%, P < 0.001) and higher contrast use (199.2 ± 81.9 vs 150.1 ± 64.0 mL, P < 0.001). At 1 year, the composite endpoint of all-cause death, vascular reintervention or new-onset claudication occurred in 34.7% of patients with BESG and 29.0% of controls (P = 0.24). After propensity matching, outcomes remained comparable (risk ratio 0.98, 95% confidence interval 0.58-1.65; P = 0.95).

Conclusion

In this retrospective single-centre cohort, BESG implantation appeared to be safe and may be an effective fully percutaneous bailout option for access-site bleeding after TF-TAVI.

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经导管主动脉瓣植入相关血管通路并发症：球囊可扩张支架移植是一个好的选择吗？

背景：经股经导管主动脉瓣植入术（TF-TAVI）最具挑战性的并发症是血管通路并发症（VACs），尽管采用了预关闭技术，但通路部位出血经常影响结果。血管内救助策略已经变得越来越普遍，尽管历史担忧支架放置在弯曲区。目的：评价带预闭装置的TF-TAVI患者采用球囊可膨胀支架（BESG）植入术治疗VACs的疗效和安全性。方法：这项回顾性单中心研究纳入了2010年1月至2020年12月期间接受TF-TAVI治疗的所有连续患者。BESG植入用于治疗闭合失败后的持续性股动脉出血。根据瓣膜学术研究联盟3 （VARC-3）标准，比较BESG受者和对照组的基线、程序和临床数据。结果：1248例患者（平均±标准差年龄83.1±7.3岁，女性占52.3%）中，持续股骨出血225例（18.0%），需要植入BESG的98例（7.8%）。与对照组相比，BESG患者的鞘尺寸更大（例如，18 Fr: 73.5% vs 47.8%）。结论：在本回顾性单中心队列中，BESG植入似乎是安全的，可能是TF-TAVI后通路部位出血的有效全经皮救助选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Archives of Cardiovascular Diseases 医学-心血管系统

CiteScore

4.40

自引率

6.70%

发文量

审稿时长

34 days

期刊介绍： The Journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles and editorials. Topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.