Vascular access complications in endovascular procedures with large sheaths

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Radiology

Background:

• Endovascular aortic repair (EVAR, TEVAR, TAVI) offers less invasive treatment options.
• Large-sheath use in these procedures is challenging due to coexisting arterial disease.
• Anticipating and managing vascular complications is crucial for patient safety.

Purpose of the Study:

• To outline strategies for preventing vascular complications through preoperative imaging.
• To detail intraoperative techniques for managing difficult arterial access.
• To discuss salvage procedures for major intraoperative vascular complications.

Main Methods:

• Review of current literature on endovascular aortic repair complications.
• Analysis of preoperative imaging techniques for arterial assessment.
• Description of endovascular and open salvage techniques for vascular injuries.

Main Results:

• Optimal preoperative imaging is key to identifying challenging arterial anatomy.
• Various intraoperative techniques can address difficult access and facilitate device deployment.
• Effective salvage strategies exist for managing major vascular complications like iliac rupture.

Conclusions:

• Proactive imaging and preparedness for access challenges improve TAVI, TEVAR, and EVAR outcomes.
• Skilled management of intraoperative complications minimizes patient morbidity.
• A comprehensive approach to vascular access and complication management is essential.