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Updated: Dec 30, 2025
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Incidence, Prognosis and Predictors of Major Vascular Complications and Percutaneous Closure Device Failure Following
Wayne Batchelor1, Krishna Patel2, Julian Hurt3
1Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA, USA.
Insights
Major vascular complications (VCs) after transfemoral transcatheter aortic valve replacement (TF-TAVR) are uncommon but increase mortality. Pelvic vessel tortuosity and coronary artery disease predict VCs, while closure device failure prolongs hospital stay.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Surgery
Background:
- Limited data exists on vascular complications (VCs) and percutaneous closure device failure (PCDF) following contemporary percutaneous transfemoral transcatheter aortic valve replacement (TF-TAVR) using large sheaths (14-16 French).
- Understanding these complications is crucial for improving patient outcomes and procedural safety.
Purpose of the Study:
- To determine the incidence, prognosis, and predictors of major Valve Academic Research Consortium (VARC-2) vascular complications (VCs) and percutaneous vascular closure device failure (PCDF) after percutaneous TF-TAVR.
- To identify patient and procedural factors associated with these complications.
Main Methods:
- A single-center retrospective analysis of 303 consecutive percutaneous TF-TAVRs performed between June 2016 and October 2018.
- Data collected included clinical and procedural characteristics, CT angiographic measurements (e.g., vessel diameters, sheath-to-artery ratios, calcification, tortuosity), and 30-day outcomes (VCs, mortality, length of stay).
- Multivariable regression analysis was used to identify independent predictors of major VCs and PCDF.
Main Results:
- The incidence of major VCs was 6.3%, minor VCs 9.6%, and PCDFs 5.6%. Overall 30-day mortality was low (2.6%).
- Major VCs were associated with significantly higher 30-day mortality (42% vs. 0%), while minor VCs and PCDFs were not.
- PCDFs were associated with a longer median length of stay (4 vs. 3 days).
- Independent predictors of major VCs included pelvic vessel tortuosity (OR 3.1) and coronary artery disease (CAD) (OR 8.2). Female gender showed a trend toward increased risk.
- No independent predictors were identified for PCDF.
Conclusions:
- Contemporary percutaneous TF-TAVR using 14-16F sheaths is associated with a low incidence of mortality, major VCs, and PCDFs.
- Major VCs significantly increase mortality risk, whereas PCDFs prolong length of stay.
- Pelvic vessel tortuosity and a history of CAD are key predictors of major VCs, highlighting the importance of pre-procedural imaging and patient selection.
Objectives:
To determine the incidence, prognosis, and predictors of major Valve Academic Research Consortium (VARC-2) vascular complications (VCs) and percutaneous vascular closure device failure (PCDF) following contemporary percutaneous transfemoral transcatheter aortic valve replacement (TF-TAVR).
Background:
Limited data exists on the incidence and predictors of VCs and PCDFs following percutaneous TF-TAVR using contemporary 14-16 French (F) sheaths.
Methods:
We recorded clinical and procedural characteristics, computer tomography (CT) angiographic data, 30-day VCs, mortality, and length of stay (LOS) in all consecutive percutaneous TF-TAVRs at a single center from June 2016 to October 2018. CT measures included common femoral artery (CFA) and external iliac artery (EIA) diameters, sheath to CFA and EIA ratios (SFAR and SEIAR), depth of CFA, extent and location of CFA calcification and pelvic vessel tortuosity (2 bends ≥90°). Multivariable regression was used to predict major VCs and percutaneous closure device failure (PCDF), respectively.
Results:
The final sample consisted of 303 percutaneous TF-TAVRs. Median age was 80 years, 51% were male, 86% Caucasian, 33% had diabetes mellitus (DM) and mean STS score was 5.8 ± 3.8%. Baseline characteristics were similar in patients with vs. without VCs, other than coronary artery disease (CAD) (69% vs. 54%, respectively; p = 0.029) and DM (21% vs. 36%, respectively; p = 0.02). There were 65 (21%) vascular complications: 19 major VCs [6.3%], 29 minor [VCs 9.6%] and 17 PCDFs [5.6%]. Overall, 30-day mortality was low (2.6%). Major VCs were associated with higher mortality (42% vs. 0%, p < 0.0001) while minor VCs (3% vs. 0%, mortality p = 0.99) and PCDFs (3% vs. 0% mortality, p = 0.99) were not. PCDFs were associated with a longer median LOS (4 vs. 3 days, p = 0.02). The independent predictors of major VCs were pelvic vessel tortuosity (OR 3.1; 95% CI 1.1-9.2) and presence of CAD (OR 8.2; 95% CI 1.8-37). Female gender showed a strong trend toward increased risk (OR 3.4; CI 0.84-14; p = 0.086). There were no independent predictors of PCDF.
Conclusion:
Contemporary percutaneous TF-TAVR is associated with a low risk of mortality, major VCs and PCDFs. Major VCs confer increased mortality and PCDFs prolong LOS. Pelvic vessel tortuosity and a history of CAD predict major VCs; there were no predictors of PCDFs. These results provide a contemporary update on the incidence and implications of these important vascular complications in the current era of percutaneous TF-TAVR using 14-16F vascular sheaths.
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