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Rigshospitalet - a part of Copenhagen University Hospital
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Safety and efficacy of using the Viabahn endoprosthesis for percutaneous treatment of vascular access complications after transfemoral aortic valve implantation

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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.

Original languageEnglish
JournalThe American journal of cardiology
Volume115
Issue number8
Pages (from-to)1123-9
Number of pages7
ISSN0002-9149
DOIs
Publication statusPublished - 15 Apr 2015

    Research areas

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

ID: 45855496