Copyright
©2014 Baishideng Publishing Group Inc.
World J Cardiol. Aug 26, 2014; 6(8): 836-846
Published online Aug 26, 2014. doi: 10.4330/wjc.v6.i8.836
Published online Aug 26, 2014. doi: 10.4330/wjc.v6.i8.836
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) |
Ref. | Bioprostheses | Population | Major vascular complications | Stenosis/ occlusion | Perforation/rupture | Dissection | Pseudoaneurysm |
Webb et al[40], Circulation 2009 | ESV | 113 | 9/113 (8%) | NA | NA | NA | NA |
Ducrocq et al[8], Eurointervention 2010 | ESV | 54 | 9/54 (16.7%) | 0/9 | 5/9 (55.5%) | 4/9 (45.5%) | 0/9 |
Tchetche et al[9], Eurointervention 2010 | ESV + MCV | 45 24 ESV 21 MCV | 4/45 (8.9%) 2/24 (8.3%) ESV 2/21 (9.5%) MCV1 | NA | NA | NA | NA |
Piazza et al[41], Eurointervention 2008 | MCV | 646 | 12/646 (1.9%) | NA | NA | NA | NA |
Himbert et al[42], JACC 2009 | ESV | 51 | 6/51 (12%) | 0/6 | 2/6 (33%) | 4/6 (66%) | 0/6 |
Webb et al[1], Circulation 2007 | ESV | 50 | 4/50 (8%) | 0/4 | 4/4 (100%) | 0/4 | 0/4 |
SOURCE registry[43], Circulation 2009 | ESV | 463 | 57/463 (12.3%) | NA | NA | NA | NA |
Lefèvre et al[44], Eur Heart J 2011 | ESV | 61 | 17/61 (28%) | 0/61 | 3/61 (5%) | 6/61 (10%) | 1/161 (2%) |
Canadian experience[45], JACC 2010 | ESV | 168 | 22/168 (13.1%) | NA | NA | NA | NA |
Bleiziffer et al[46], J ThoracCardiovasc Surg 2009 | MCV | 153 | 24/153 (16%) | NA | NA | NA | NA |
The Milan experience JACC Cardiovasc Interv 2010[47] | ESV + MCV | 107 61 ESV 46 MCV | 22 /107 (20.6%) 13/61 (21.3%) ESV 9/46 (19.5%) MCV1 | 1/22 (4.5%) ESV | 7/22 (32%) 5/13 (38%) ESV 2/9 (22%) MCV1 | 6/22 (27%) 4/13 (31%) ESV 2/9 (22%) MCV1 | 4/22 (18%) MCV |
The Rotterdam experience[7], Eurointervention 2010 | MCV | 99 | 13/99 (13%) | NA | NA | NA | NA |
The France Registry[48], Eur Heart J 2011 | ESV + MCV | 160 94 ESV 66 MCV | 11/160 (7%) 6/94 (6.4%) ESV 5/66 (7.6%) MCV1 | 0/11 | 2/11 (18%) ESV | 7/11 (64%) 4/6 (67%) ESV 3/5 (60 %) MCV1 | 0/11 |
Petronio et al[49], Circ Cardiovasc Interv 2010 | MCV | 460 | 9/460 (2%) | NA | NA | NA | NA |
Spanish experience[50], Rev Espan Cardiol 2010 | MCV | 108 | 6/108 (5.6%) | 1/6 (16.6%) | 1/6 (16.6%) | 0/6 | 1/6 (6.60%) |
United Kingdom Registry[51], JACC 2011 | ESV + MCV | 599 193 ESV 406 MCV | 50/599 (8.4%) | NA | NA | NA | NA |
Toggweiler et al[15], JACC 2012 | ESV+ MCV | 137 126 ESV 11 MCV | 24/137 (18%)2 | 16/24 (66.6%) | 2/24 (8.3%) | 2/24 (8.3%) | 2/24 (8.3%) |
Partner trial[52], JACC 2012 | ESV | 419 | 64/419 (15.3%) | NA | 20/64 (31.3%) | 40/64 (62.8%) | 2/64 (3.4%) |
The France II Registry[53], NEJM 2013 | ESV + MCV | 3195 2107 ESV 1043 MCV | 150/3195 (4.7%) 57/2107 (2.7%) 47/1043 (4.5%) | NA | NA | NA | NA |
European Sentinel Registry of TAVI[54], Eurointervention 2013 | ESV + MCV | 4571 2604 ESV3 1943 MCV | 40/4571 (3.1%) 20/2604 (3.3%) 20/1943 (2.8%) | NA | NA | NA | NA |
Sawa et al[55], Circulation Journal 2014 | MCV | 44 | 5/44 (11.54%) | NA | NA | NA | NA |
Spanish National Registry of TAVI[56], Rev Esp Cardiol 2013 | ESV + MCV | 1159 504 ESV 610 MCV | 42/1159 (3.6%) 25/504 (5%) 17/610 (2.8%) | NA | NA | NA | NA |
Total | 12862 | 640/12862 (5%) | 18/143 (12.6%) | 44/207 (21.2%) | 69/207 (33.3%) | 10/207 (4.8%) |
Complication | Type of bailout endovascular intervention | Devices needed |
Any type | Immediate angiography and prompt access to the affected iliac-femoral axis1 | 6-9 F long (45 cm) sheaths |
Iliac-femoral arteries rupture/ perforation | Immediate hemostasis to avoid shock | Large peripheral balloons in iliac arteries (diameter: 7-10 mm) or elastomeric balloon in the distal aorta |
Vascular sealing in case of persistent blood extravasation after prolonged balloon inflation | Covered stent (diameter: 7-10 mm) | |
Failure of hemostasis at the entry site | Prolonged balloon inflation proximal to the entry site during external manual compression | Mid-sized peripheral balloons (diameter: 6-8 mm) |
Iliac-femoral arteries flow-limiting dissection | Immediate restoration of antegrade flow to avoid acute limb ischemia | Large peripheral balloons (diameter: 7-10 mm) |
Vascular sealing in case of significant stenosis/dissection after balloon inflation | Peripheral self-expandable nitinol stents (diameter: 7-10 mm) | |
Iliac-femoral arteries acute thrombotic occlusion | Immediate restoration of antegrade flow to avoid acute limb ischemia | Thrombus aspiration with thrombus-extraction devices (angiojet, thrombus-aspirating catheters) or with coronary guiding catheters (multipurpose curve) Peripheral balloons (diameter: 5-10 mm) Consider distal filter protection to avoid embolization and avoid aggressive dilations since dethrombosis is usually facilitated by antegrade flow restoration |
- Citation: Dato I, Burzotta F, Trani C, Crea F, Ussia GP. Percutaneous management of vascular access in transfemoral transcatheter aortic valve implantation. World J Cardiol 2014; 6(8): 836-846
- URL: https://www.wjgnet.com/1949-8462/full/v6/i8/836.htm
- DOI: https://dx.doi.org/10.4330/wjc.v6.i8.836