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Related Experiment Video

Updated: May 2, 2026

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
06:04

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation

Published on: August 8, 2025

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CT-Guided Risk Stratification for Selective Femoral Protection Guidewire Use in Transfemoral TAVI.

Francesco Bianchini1, Mattia Lunardi1, Enrico Romagnoli1

  • 1Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

The American Journal of Cardiology
|April 30, 2026
PubMed
Summary

Vascular complications after transfemoral transcatheter aortic valve implantation (TF-TAVI) affect 13.3% of patients, increasing mortality and bleeding risk. Pre-procedural CT imaging can identify patients with "fragile access" anatomy, guiding protective strategies.

Keywords:
calcificationiliofemoral accessmultislice computed tomographytranscatheter aortic valve implantationvascular complications

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Area of Science:

  • Cardiovascular Interventions
  • Medical Imaging
  • Vascular Surgery

Background:

  • Vascular and bleeding complications are common after transfemoral transcatheter aortic valve implantation (TF-TAVI), despite procedural advancements.
  • Optimal strategies to minimize these complications remain unclear.
  • Streamlining TF-TAVI by omitting femoral protection may suit low-risk patients.

Purpose of the Study:

  • To determine the incidence and clinical impact of ilio-femoral vascular events post-TF-TAVI.
  • To identify multislice computed tomography (MSCT)-derived predictors for selective use of femoral protection.

Main Methods:

  • Analysis of 960 consecutive TF-TAVI patients with pre-procedural MSCT.
  • Primary endpoint: 30-day vascular events (access complications or balloon hemostasis need).
  • Multivariable logistic regression identified independent predictors.

Main Results:

  • 13.3% of patients experienced vascular events, primarily access complications (9.8%) and balloon hemostasis (3.5%).
  • Predictors included female sex, sheath-to-artery ratio (STAR) >1, and extensive ilio-femoral calcification (≥90°).
  • Vascular events correlated with higher 30-day mortality and major bleeding.

Conclusions:

  • Operative ilio-femoral vascular events occur in approximately 1 in 8 TF-TAVI patients.
  • A CT-identified "fragile access" profile (female sex, STAR >1, diffuse calcification) can guide protective strategies.
  • CT-based selection allows tailored approaches, reducing invasiveness for favorable anatomy.