Femoral vessel complications after transfemoral TAVR—A contemporary sonography‐based assessment of 480 patients with third‐generation transcatheter valves

Abstract

AbstractBackgroundPostinterventional sonographic assessment of the femoral artery after transfemoral transcatheter aortic valve replacement (TF‐TAVR) has the potential to identify several pathologies. We investigated the incidence and risk factors of femoral vessel complications in a modern TAVR collective using postinterventional sonography.MethodsBetween September 2017 and March 2022, 480 patients underwent TF‐TAVR with postinterventional femoral sonography at a single center. Clinical outcomes and adverse events were analyzed after the Valve Academic Research Consortium 3 (VARC‐3) criteria.ResultsIn this cohort (51.2% male; age 80 ± 7.5 years, median EuroSCORE II 3.7) 74.8% (n = 359) were implanted with a self‐expandable and 25.2% (n = 121) with a balloon‐expandable valve. The main access (valve‐delivery) was located right in 91.4% (n = 438), and the primary closure system was Proglide in 95% (n = 456). Vascular complications (VC) were observed in 29.16% (n = 140) of patients; 23.3% (n = 112) presented with minor‐ and 5.8% (n = 28) with major VC. Postinterventional femoral artery stenosis on the main access was observed in 9.8% (n = 47). Multivariable logistic regression analysis revealed female sex (p = .03, odds ratio [OR] 2.32, 95% confidence interval [CI] 1.09–4.89) and the number of used endovascular closure devices (p = .014, OR 0.11, 95%CI 0.02–0.64) as predictive factors for femoral artery stenosis.ConclusionsThe incidence of postinterventional femoral artery stenosis following TF‐TAVR was higher than expected with a number of used closure devices and female sex being independent risk factors. Considering the continuous advance of TAVR in low‐risk patients with preserved physical activity, emphasis should be directed at the correct diagnosis and follow‐up of these complications.