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Updated: Dec 26, 2025
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Ultrasound Guidance to Reduce Vascular and Bleeding Complications of Percutaneous Transfemoral Transcatheter Aortic
Flavien Vincent1,2,3, Hugues Spillemaeker1,2,3, Maéva Kyheng4
1Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France.
Insights
Ultrasound (US) guidance significantly reduced vascular and bleeding complications during transfemoral transcatheter aortic valve replacement. This method should be considered the standard for arterial puncture in these procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Transfemoral transcatheter aortic valve replacement (TAVR) involves arterial puncture, a potential source of complications.
- Ultrasound (US) guidance offers precise control over the puncture zone, potentially mitigating risks.
- Previous studies have suggested benefits, but robust comparative data is needed.
Purpose of the Study:
- To evaluate the clinical impact of US guidance versus fluoroscopic guidance for arterial puncture in TAVR.
- To compare vascular and bleeding complication rates between US-guided and fluoroscopic-guided TAVR procedures.
Main Methods:
- A propensity score-matched analysis compared US-guided and fluoroscopic-guided TAVR using second-generation devices.
- A separate analysis described outcomes in a cohort of patients undergoing US-guided TAVR with third-generation devices.
- Vascular complications (VC) and bleeding events were the primary endpoints.
Main Results:
- US guidance significantly reduced VC (16.8% vs 6.3%) and bleeding complications (22.1% vs 6%) in the second-generation TAVR group.
- VC related to vascular access was also lower with US guidance (12.6% vs 4.2%).
- In the third-generation group, major VC and bleeding rates were 3.2% and 3.6%, respectively. Life-threatening bleeding increased mortality risk by 1.7-fold.
Conclusions:
- Ultrasound guidance is effective in reducing vascular and bleeding complications during transfemoral TAVR.
- US guidance should be considered the standard method for arterial puncture in TAVR procedures.
- The adoption of US guidance is associated with improved safety outcomes in TAVR.
Abstract:
Background Ultrasound (US) guidance provides the unique opportunity to control the puncture zone of the artery during transfemoral transcatheter aortic valve replacement and may decrease major vascular complications (VC) and life-threatening or major bleeding complications. This study aimed to evaluate the clinical impact of US guidance using a propensity score-matched comparison. Methods and Results US guidance was implemented as the default approach for all transfemoral transcatheter aortic valve replacement cases in our institution in June 2013. We defined 3 groups of consecutive patients according to the method of puncture (fluoroscopic/US guidance) and the use of a transcatheter heart valve. Patients in the US-guided second-generation group (Sapien XT [Edwards Lifesciences, Irvine, CA], Corevalve [Medtronic, Dublin, Ireland]) were successfully 1:1 matched with patients in the fluoroscope-guided second-generation group (n=95) with propensity score matching. In a second analysis we described the consecutive patients of the US-guided third-generation group (Evolut-R [Medtronic], Sapien 3 [Edwards Lifesciences], n=308). All vascular and bleeding complications were reduced in the US-guided second-generation group compared with the fluoroscope-guided second-generation group: VC (16.8% versus 6.3%; P=0.023); life-threatening or major bleeding (22.1% versus 6%; P=0.004); and VC related to vascular access (12.6% versus 4.2%; P=0.052). In the US-guided third-generation group the rates of major VC and life-threatening or major bleeding were 3.2% (95% CI, 1.6% to 5.9%) and 3.6% (95% CI, 1.8% to 6.3%). In the overall population (n=546), life-threatening or major bleeding was associated with a 1.7-fold increased mortality risk (P=0.02). Conclusions We demonstrated that US guidance effectively reduced VC and bleeding complications for transfemoral transcatheter aortic valve replacement and should be considered the standard puncture method. Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02628509.
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