Management of vascular complications following transcatheter aortic valve implantation

Arch Cardiovasc Dis. 2015 Oct;108(10):491-501. doi: 10.1016/j.acvd.2015.03.007.


Background: Vascular complications (VCs) after transcatheter aortic valve implantation (TAVI) are frequent and their management is challenging.

Aim: To report the incidence, predictors and management of VCs following percutaneous transfemoral TAVI (TF-TAVI) at a single centre.

Methods: We analyzed 102 consecutive patients who underwent percutaneous TF-TAVI between August 2008 and December 2013. All endpoints were evaluated at 30 days and 6 months according to Valve Academic Research Consortium-2 criteria. VC percutaneous treatment success was defined as residual stenosis<30%, absence of blood extravasation and absence of surgical or repeat endovascular intervention at 30 days.

Results: Twenty-two patients (22%) experienced VCs, including five patients (5%) with major VCs. Mortality at 30 days was significantly higher in patients with major VCs than in patients without major VCs (60% vs 3%; P=0.001). Patients with VCs had more life-threatening or major bleeding (23% vs 5%; P=0.02), but no difference in terms of need for blood transfusion was observed. Endovascular treatment was used in 13 of 22 patients with VCs (59%) and was successful in 11 of these 13 patients (85%). Primary surgical repair was necessary in only 1/22 (5%) patients, for a common femoral artery pseudoaneurysm 2 weeks after the TAVI procedure.

Conclusions: VCs following TF-TAVI are frequent. Major but not minor VCs are associated with increased mortality. Percutaneous management of VCs is feasible and safe, and surgery is rarely needed.

Keywords: Complication vasculaire; Covered stent; Intervention vasculaire périphérique; Peripheral intervention; Remplacement valvulaire aortique percutané; Stent couvert; Transcatheter aortic valve implantation; Vascular complication.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve Insufficiency / diagnosis
  • Aortic Valve Insufficiency / mortality
  • Aortic Valve Insufficiency / physiopathology
  • Aortic Valve Insufficiency / therapy*
  • Aortic Valve Stenosis / diagnosis
  • Aortic Valve Stenosis / mortality
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / therapy*
  • Aortic Valve* / physiopathology
  • Cardiac Catheterization / adverse effects*
  • Cardiac Catheterization / instrumentation
  • Cardiac Catheterization / methods
  • Cardiac Catheterization / mortality
  • Databases, Factual
  • Endovascular Procedures* / adverse effects
  • Endovascular Procedures* / mortality
  • Feasibility Studies
  • Female
  • Heart Valve Prosthesis
  • Heart Valve Prosthesis Implantation / adverse effects*
  • Heart Valve Prosthesis Implantation / instrumentation
  • Heart Valve Prosthesis Implantation / methods
  • Heart Valve Prosthesis Implantation / mortality
  • Humans
  • Incidence
  • Male
  • Retreatment
  • Retrospective Studies
  • Severity of Illness Index
  • Switzerland / epidemiology
  • Time Factors
  • Treatment Outcome
  • Vascular Diseases / diagnosis
  • Vascular Diseases / mortality
  • Vascular Diseases / therapy*