Interventions for valvular disease and heart failure

Incidence and predictors of vascular complications in transaxillary TAVI

EuroIntervention 2020;15:e1325-e1331. DOI: 10.4244/EIJ-D-19-00588

Kees van der Wulp
Kees van der Wulp1, MD; Ina Thijs1, BSc; Marleen van Wely1, MD; Anton Loverbos1, BSc; Helmut Gehlmann1, MD; Michel Verkroost2, MD; Leen Van Garsse2, MD, PhD; Peter Kievit1, MD, PhD; Priya Vart3, DMD; Saloua El Messaoudi1, MD, PhD; Dennis Bosboom4, MD, PhD; Wim Morshuis2, MD, PhD; Niels van Royen1, MD, PhD
1. Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands; 2. Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; 3. Department of Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands; 4. Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands

Aims: Vascular complications are among the most commonly observed complications after TAVI. Iliofemoral vascular outcome has been described extensively. Little is known about vascular complications in transaxillary TAVI. The aim of the current study was to describe the incidence and predictors of axillary artery complications incorporating computed tomography angiography (CTA) measurements.

Methods and results: CT analysis was performed in two hundred patients treated with transaxillary TAVI in our centre between January 2014 and December 2017. Vascular complications occurred in 37 (18.5%) patients. Patient characteristics predicting this outcome were female gender (aOR 3.88 [1.48-10.14], p=0.006) and age (aOR 1.08 [1.01-1.16], p=0.034). The CTA measurement predicting vascular complications was a sheath to artery area ratio (SAAR) equal to or larger than 1.63 (OR 3.95 [1.29-12.12], p=0.016).

Conclusions: The present study describes the incidence of axillary artery complications and identifies patient characteristics associated with this outcome. CTA analysis was shown to be an important screening tool in the assessment of patient (access) eligibility. Axillary artery dimensional screening should be based on vascular luminal area assessment rather than diameter measurement alone.

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Interventions for valvular diseasePeripheral interventionsTAVIOther peripheral interventions
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