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Anatomy of Risk: Decoding the Predictors of Vascular Access Complications in Transcatheter Aortic Valve Replacement
Hunter T Row1, Anyamaria Edwards1, Johnathan Beaudrie1
1Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, United States.
Insights
Vascular access complications (VAC) during transcatheter aortic valve replacement (TAVR) are linked to aortoiliac disease and common femoral artery calcification. Preoperative assessment of these factors can help reduce TAVR complications.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Vascular Surgery
Background:
- Vascular access complications (VAC) are a major concern in transcatheter aortic valve replacement (TAVR).
- Identifying pre-operative risk factors is crucial for improving TAVR outcomes.
- Current risk stratification methods for TAVR access sites require refinement.
Purpose of the Study:
- To identify pre-operative anatomic risk factors for vascular access complications (VAC) in patients undergoing TAVR.
- To evaluate the predictive value of TransAtlantic intersociety consensus (TASC) scores, ilio-femoral tortuosity, and procedural characteristics for VAC.
- To correlate specific vascular imaging findings with the incidence of VAC during TAVR.
Main Methods:
- Retrospective review of 1089 TAVR patients from 2012-2022.
- Pre-operative computed tomography angiography (CTA) for detailed vascular analysis of the aortoiliac and femoral arteries.
- Statistical analysis using Wilcoxon signed-rank test, t-test, Chi-square, and Fisher's exact tests to assess associations with VAC.
Main Results:
- Aortoiliac disease burden and posterior common femoral artery (CFA) calcification were significant predictors of VAC.
- Iliofemoral tortuosity and skin-to-CFA depth did not predict VAC.
- Left CFA access was associated with VAC (p < 0.001), while iliac artery pretreatment reduced VAC odds (OR 0.21).
Conclusions:
- Preoperative peripheral vascular assessment is vital for TAVR planning.
- Aortoiliac disease, posterior CFA calcification, and left CFA access are key risk factors for TAVR-related VAC.
- A structured preoperative approach can optimize TAVR planning and improve patient outcomes.
Background:
Despite advancements in valve implantation devices, vascular access complications (VAC) remain a significant cause of morbidity and mortality for those undergoing transcatheter aortic valve replacement (TAVR). We describe pre-operative imaging analysis of the aortoiliac and femoral arterial beds using the TransAtlantic intersociety consensus (TASC) score, ilio-femoral tortuosity, and procedural characteristics to identify anatomic risk factors predictive of VAC in TAVR.
Methods:
Consecutive patients undergoing TAVR from 2012 to 2022 at a single North Dakota hospital were retrospectively reviewed. Pre-operative computed tomography angiography (CTA) was used for vascular analysis of the infrarenal aorta, iliac, and femoral vascular beds. Wilcoxon signed-rank test was used for non-normally distributed or t-test for normally distributed continuous variables and Chi-square or Fisher's exact tests for categorical variables were utilized to examine the association of each variable with vascular complications.
Results:
One thousand eighty-nine patients were evaluated with 80 patients identified with VAC. Aortoiliac disease burden of the iliac arteries and posterior wall calcification of the common femoral artery (CFA) were predictive of VAC. Iliofemoral tortuosity and skin to CFA depth were not. Left sided CFA versus right CFA access was associated (p < 0.001). Pretreatment of diseased iliac vessels decreased odds of VAC (OR 0.21, 95% CI, 0.08-0.56).
Conclusion:
Our study highlights the importance of preoperative peripheral vascular assessment for TAVR. We identify aortoiliac disease burden, posterior CFA calcification, and left sided common femoral access as risk factors for VAC. A structured approach to the preoperative assessment may optimize planning and enhance outcomes in TAVR.
