Percutaneous management of vascular access in transfemoral transcatheter aortic valve implantation

Table 1 Valve academic research consortium-2 classification of vascular access site and access-related complications

Major vascular complications

Any aortic dissection, aortic rupture, annulus rupture, left ventricle perforation, or new apical aneurysm/pseudoaneurysm OR

Access site or access-related vascular injury (dissection, stenosis, perforation, rupture, arterio-venous fistula, pseudoaneurysm, hematoma, irreversible nerve injury, compartment syndrome, percutaneous closure device failure) leading to death, life-threatening or major bleeding1, visceral ischemia or neurological impairment OR

Distal embolization (non-cerebral) from a vascular source requiring surgery or resulting in amputation or irreversible end-organ damage OR

The use of unplanned endovascular or surgical intervention associated with death, major bleeding, visceral ischemia or neurological impairment OR

Any new ipsilateral lower extremity ischemia documented by patient symptoms, physical exam, and/or decreased or absent blood flow on lower ex tremity angiogram OR

Surgery for access site-related nerve injury OR

Permanent access site-related nerve injury

Minor vascular complications

Access site or access-related vascular injury (dissection, stenosis, perforation, rupture, arterio-venous fistula, pseudoaneurysms , hematomas, percutaneous closure device failure) not leading to death, life-threatening or major bleeding1, visceral ischemia or neurological impairment OR

Distal embolization treated with embolectomy and/or thrombectomy and not resulting in amputation or irreversible end-organ damage OR

Any unplanned endovascular stenting or unplanned surgical intervention not meeting the criteria for a major vascular complication OR

Vascular repair or the need for vascular repair (via surgery, ultrasound-guided compression, transcatheter embolization, or stent-graft)

Percutaneous closure device failure

Failure of a closure device to achieve hemostasis at the arteriotomy site leading to alternative treatment (other than manual compression or adjunctive endovascular ballooning)

¹Refers to valve academic research consortium bleeding definitions[37].