Ultrasound versus angiographic guided access in transfemoral TAVI: intra-operator evaluation of vascular and bleeding...

Both angiography roadmap (RM) and ultrasound (US) are commonly used to obtain femoral arterial access during transfemoral transcatheter aortic valve implantation (TAVI). In this analysis, we sought to evaluate the effect of implementation of an US-guided approach on vascular and bleeding complications.

Vascular complications and bleeding at the main access site were compared using 4-year data from two experienced TAVI-operators, who changed their practice from an exclusively RM- to an exclusively US-guided technique for access in transfemoral TAVI.

A total of 1026 patients were analyzed (RM: n = 485, US: n = 541) with a mean age of 80.7 ± 6.3 years; 47.7% were female and 37.1% received a balloon-expandable valve. Main access vascular complications, bleedings, or their composite were lower in the US-group (RM vs. US: 16.1% vs. 8.3%, p < 0.001). US was a protective factor for vascular complications, bleeding and their composite (adjusted odds ratio [OR] 0.51, 95%-confidence interval [CI] 0.33-0.77, p = 0.002; adjusted OR 0.46, 95%-CI 0.28-0.78, p = 0.003; and adjusted OR: 0.47; 95% CI 0.32-0.70, p < 0.001, respectively). Fluoroscopy time (14 [interquartile range (IQR) 11 - 20] min vs. 13 [IQR 10 - 17] min, p < 0.001), contrast use (88 [IQR 69 - 111] ml vs. 84 [IQR 65 - 110] ml, p = 0.049) and procedure time (52 [IQR 44 - 67] min vs. 49 [IQR 41 - 62] min, p = 0.02) were lower in the US-group.

US-guided femoral access was associated with significantly fewer complications compared with RM-guidance, supporting its adoption even among operators experienced with angiographic guidance.