Percutaneous management of vascular access in transfemoral transcatheter aortic valve implantation

Abstract

Transcatheter aortic valve implantation (TAVI) using stent-based bioprostheses has recently emerged as a promising alternative to surgical valve replacement in selected patients. The main route for TAVI is retrograde access from the femoral artery using large sheaths (16-24 F). Vascular access complications are a clinically relevant issue in TAVI procedures since they are reported to occur in up to one fourth of patients and are strongly associated with adverse outcomes. In the present paper, we review the different types of vascular access site complications associated with transfemoral TAVI. Moreover, we discuss the possible optimal management strategies with particular attention to the relevance of early diagnosis and prompt treatment using endovascular techniques.

Keywords: Transfemoral transcatheter aortic valve implantation, Vascular access complication, Percutaneous management

Core tip: Vascular complications are not rare in transcatheter aortic valve implantation (TAVI) by the transfemoral approach and can significantly affect the overall clinical outcome. After diagnosis, the application of simple vascular interventional techniques allows efficient complication management, thus avoiding high risk vascular surgery. We discuss the available percutaneous vascular access preparation by dedicated devices, the principal diagnostic tools for prevention and detection of vascular complications and their percutaneous management in the transfemoral TAVI setting.