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  • Title: Percutaneous management of vascular complications in patients undergoing transcatheter aortic valve implantation.
    Author: Stortecky S, Wenaweser P, Diehm N, Pilgrim T, Huber C, Rosskopf AB, Khattab AA, Buellesfeld L, Gloekler S, Eberle B, Schmidli J, Carrel T, Meier B, Windecker S.
    Journal: JACC Cardiovasc Interv; 2012 May; 5(5):515-524. PubMed ID: 22625190.
    Abstract:
    OBJECTIVES: This study sought to investigate the feasibility and safety of percutaneous management of vascular complications after transcatheter aortic valve implantation (TAVI). BACKGROUND: Vascular complications after TAVI are frequent and outcomes after percutaneous management of these adverse events not well established. METHODS: Between August 2007 and July 2010, 149 patients underwent transfemoral TAVI using a percutaneous approach. We compared outcomes of patients undergoing percutaneous management of vascular complications with patients free from vascular complications and performed duplex ultrasonography, fluoroscopy, and multislice computed tomography during follow-up. RESULTS: A total of 27 patients (18%) experienced vascular complications consisting of incomplete arteriotomy closure (n = 19, 70%), dissection (n = 3, 11%), arterial perforation (n = 3, 11%), arterial occlusion (n = 1, 4%), and pseudoaneurysm (n = 1, 4%). Percutaneous stent graft implantation was successful in 21 of 23 (91%) patients, whereas 2 patients were treated by manual compression, 2 patients underwent urgent surgery, and 2 patients required delayed surgery. Rates of major adverse cardiac events at 30 days were similar among patients undergoing percutaneous management of vascular complications and those without vascular complications (9% vs. 8%, p = 1.00). After a median follow-up of 10.9 months, imaging showed no evidence of hemodynamically significant stenosis (mean peak velocity ratio: 1.2 ± 0.4). Stent fractures were observed in 4 stents (22%, type I [6%], type II [16%]) and were clinically silent in all cases. CONCLUSIONS: Vascular complications after TAVI can be treated percutaneously as a bailout procedure with a high rate of technical success, and clinical outcomes are comparable to patients without vascular complications. Stent patency is high during follow-up, although stent fractures require careful scrutiny.
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