Safety and efficacy of using the Viabahn endoprosthesis for percutaneous treatment of vascular access complications after transfemoral aortic valve implantation

Am J Cardiol. 2015 Apr 15;115(8):1123-9. doi: 10.1016/j.amjcard.2015.01.547. Epub 2015 Feb 3.


Vascular access complications (VACs) remain one of the biggest challenges when performing transcatheter aortic valve implantation (TAVI). This study aimed to investigate the short- and medium-term safety and efficacy of the Viabahn endoprosthesis (Gore, Flagstaff, AZ) when used to treat TAVI-induced vascular injury. Over a 40-month period, 354 patients underwent true percutaneous transfemoral (TF)-TAVI using a CoreValve and Prostar-XL closure system; this was our study population. A VAC leading to acute intervention occurred in 72 patients (20.3%) - of these, 18 were managed by balloon angioplasty, 48 were treated by Viabahn stenting (technical success rate 98%), and 6 needed surgical intervention. Overall, this approach resulted in a major VAC rate of 3.1% (n = 11) in our study cohort. Length of hospitalization and 30-day mortality rates were comparable in patients with a VAC treated by Viabahn stenting versus patients without vascular complications. Two patients (4.5%) presented with new-onset claudication; one of them had the stent implanted covering the deep femoral artery (DFA). At medium-term follow-up (median 372 days; range 55 to 978 days) duplex ultrasound showed 100% patency of the Viabahn endoprostheses with no signs of stent fracture or in-stent stenosis/occlusion. In conclusion, the use of self-expanding covered stents is safe and effective in case of TF-TAVI-induced vascular injury, with good short- and medium-term outcomes. Importantly, coverage of the DFA should be avoided. If confirmed by long-term (>5 years) follow-up studies, this strategy for treating TAVI-induced VAC may be used routinely in high-risk patients.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiography
  • Aortic Valve Stenosis / surgery*
  • Arterial Occlusive Diseases / diagnosis
  • Arterial Occlusive Diseases / etiology
  • Arterial Occlusive Diseases / surgery*
  • Blood Vessel Prosthesis*
  • Cardiac Catheterization / adverse effects*
  • Endovascular Procedures / methods*
  • Female
  • Femoral Artery
  • Follow-Up Studies
  • Humans
  • Male
  • Prosthesis Design
  • Time Factors
  • Tomography, X-Ray Computed
  • Transcatheter Aortic Valve Replacement / adverse effects*
  • Transcatheter Aortic Valve Replacement / methods
  • Treatment Outcome