The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Vascular complications in Transaxillary TAVI: Incidence and predictors incorporating CTA measurements

DOI: 10.4244/EIJ-D-19-00588

1. Radboudumc, Cardiology, Nijmegen, Netherlands
2. Department of Cardiology, Radboud university medical centre, Nijmegen, The Netherlands
3. Department of Cardiology, Radboud university medical centre, Nijmegen, The Netherlands
4. Department of Cardiology, Radboud university medical centre, Nijmegen, The Netherlands
5. Department of Cardiology, Radboud university medical centre, Nijmegen, The Netherlands
6. Department of Cardiothoracic Surgery, Radboud university medical centre, Nijmegen, The Netherlands
7. Department of Cardiothoracic Surgery, Radboud university medical centre, Nijmegen, The Netherlands
8. Department of Cardiology, Radboud university medical centre, Nijmegen, The Netherlands
9. Department of Health Evidence, Radboud university medical centre, Nijmegen, The Netherlands
10. Department of Cardiology, Radboud university medical centre, Nijmegen, The Netherlands
11. Department of Radiology, Radboud university medical centre, Nijmegen, The Netherlands
12. Department of Cardiothoracic Surgery, Radboud university medical centre, Nijmegen, The Netherlands
13. Department of Cardiology, Radboud university medical centre, Nijmegen, The Netherlands, Netherlands
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Aims: Vascular complications are among the most common observed complications after TAVI. Ileofemoral 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 described the incidence of axillary artery complications and identified patient characteristics associated with this outcome. CTA analysis was shown to be an important screening tool in the assessment of patient’s (access) eligibility. Axillary artery dimensional screening should be based on vascular luminal area assessment rather than diameter measurement alone.

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