Comparison of Frequency of Vascular Complications With Ultrasound-Guided Versus Fluroscopic Roadmap-Guided Femoral Arterial Access in Patients Who Underwent Transcatheter Aortic Valve Implantation

https://doi.org/10.1016/j.amjcard.2020.07.013Get rights and content

To compare outcomes of ultrasound guidance (USG) versus fluoroscopy roadmap guidance (FG) angiography for femoral artery access in patients who underwent transfemoral (TF) transcatheter aortic valve implantation (TAVI) to determine whether routine USG use was associated with fewer vascular complications. Vascular complications are the most frequent procedural adverse events associated with TAVI. USG may provide a decreased rate of access site complications during vascular access compared with FG. Patients who underwent TF TAVI between July 2012 and July 2017 were reviewed and outcomes were compared. Vascular complications were categorized by Valve Academic Research Consortium-2 criteria and analyzed by a multivariable logistic regression adjusting for potential confounding risk factors including age, gender, body mass index, peripheral vascular disease, Society of Thoracic Surgeons score and sheath to femoral artery ratio. Of the 612 TAVI patients treated, 380 (63.1%) were performed using USG for access. Routine use of USG began in March 2015 and increased over time. Vascular complications occurred in 63 (10.3%) patients and decreased from 20% to 3.9% during the study period. There were fewer vascular complications with USG versus FG (7.9% vs 14.2%, p = 0.014). After adjusting for potential confounding risk factors that included newer valve systems, smaller sheath sizes and lower risk patients, there was still a 49% reduction in vascular complications with USG (odds ratio 0.51, 95% confidence interval 0.29 to 0.88, p = 0.02). In conclusion, USG for TF TAVI was associated with reduced vascular access site complications compared with FG access even after accounting for potential confounding risk factors and should be considered for routine use for TF TAVI.

Section snippets

Methods

A retrospective review of all TF-TAVI procedures performed in a single center between July 2012 and July 2017 was conducted. All patients implanted with both balloon expandable or self-expanding valves were included with sheath size ranging from 14-Fr to 20-Fr. We excluded patients who underwent TF-TAVI with the first generation SAPIEN (Edwards Lifesciences, Irvine, CA) due to the larger sheath size and in order to maintain a patient population most representative of contemporary practice. All

Results

A total of 612 TAVI patients were included in the study; 380 (62.1%) with USG, and 232 (37.9%) with FG. The year 2015 was the inflection point for access guidance (USG access: 52%; FG access 48%) with higher USG use afterward (Figure 3). Patients who underwent USG access were more commonly female, younger, with lower STS score, and higher BMI (Table 1). The prevalence of diabetes, hypertension, and coronary artery disease were similar between the 2 groups. Patients with USG access had a median

Discussion

Our study conducted in a single center, demonstrates that USG access for TAVI is associated with a significant reduction in access-related vascular complications compared with conventional FG access. This association remains significant even after adjusting for various potential confounders including differences in patient co-morbidities, STS score and SFAR. Our study also showed a decrease in VARC-2 vascular complications over time, with a 3.9% rate of vascular complications with the use of

Disclosures

Dr. Srinivasa Potluri is a speaker and on the advisory panel for Boston Scientific, Edwards, Medtrontic, Janssen, and Terumo. The authors declare that they have no known competing financial interests or personal relations that could have appeared to influence the work reported in this study.

Authors’ Contribution

Srinivasa P. Potluri, Mohanad Hamandi, Sukhdeep S. Basra: Writing- Original draft preparation, methodology.

Kathryn V. Shinn, Deborah Tabachnick, Anupama Vasudevan, Giovanni Filardo: Data curation and data analysis

J. Michael DiMaio, William T. Brinkman, Katherine Harrington, John J. Squiers, Molly I. Szerlip, David L. Brown, Elizabeth Holper, Michael J. Mack: Writing - Reviewing and Editing.

References (25)

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