Vascular access site injury after transfemoral transcatheter aortic valve insertion Journal Article

Authors: Greason, K. L.; Suri, R. M.; Huebner, M.; Reeder, G. S.; Williamson, E. E.; Nkomo, V. T.; Rihal, C. S.; Mathew, V
Article Title: Vascular access site injury after transfemoral transcatheter aortic valve insertion
Abstract: BACKGROUND: Vascular complications associated with transfemoral transcatheter aortic valve insertion (TAVI) are a frequent untoward consequence of arterial sheath insertion. We report the prevalence of anatomic arterial injury with open artery access TAVI. METHODS: This review consisted of 53 consecutive patients who received transfemoral Sapien 23 or 26 mm TAVI via the 22- or 24-French sheath through open artery access from November 2008. The median age of the patients was 83 years (range, 59 to 94), and there were 31 males (58%). All arteries were examined to determine the optimal point of access and then explored after removal of the sheath to document injury. RESULTS: The accessed artery had a minimal lumen diameter of 8.9 mm (7.2 to 14.7) and a sheath-to-artery ratio of 1.0 (0.6 to 1.2). The point of access was the common femoral artery in 33 patients (62%) and the external iliac artery in 20 (38%). Exploration of the artery demonstrated localized arterial injury in 22 patients (42%). Female gender was predictive of injury (p = 0.03), but arterial access site location, presence of arterial access calcification, sheath-to-artery ratio, and sheath size were not. Techniques of artery repair included primary closure in 34 patients (64%), pericardial patch angioplasty in 15 (28%), and graft interposition in 4 (8%). There was one minor groin wound complication. CONCLUSIONS: Open artery access allows for direct examination and optimal access site choice of the vessel during transfemoral TAVI. Localized arterial injury was commonly encountered after 22- and 24-French sheath insertion, but the associated artery repair complication rate was low.
Journal Title: Journal of cardiac surgery
Volume: 28
Issue: 4
ISSN: 1540-8191; 0886-0440
Publisher: Wiley Periodicals, Inc  
Journal Place: United States
Date Published: 2013
Start Page: 348
End Page: 352
Language: eng
Notes: LR: 20130724; CI: (c) 2013; JID: 8908809; ppublish