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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Safety of Selective and Routine Femoral Access Angiography Post-Transcatheter Aortic Valve Implantation
Alexander von Ehr1, Jonathan Rilinger2, Derek Hazard3
1Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany; DZHK (German Centre for Cardiovascular Research), Berlin, Germany; Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Virchow Klinikum, Berlin, Germany.
Insights
Routine postprocedural angiography after transfemoral transcatheter aortic valve implantation (TF-TAVI) may not be necessary. Selective angiography guided by clinical suspicion offers comparable outcomes to routine surveillance, potentially reducing minor complication detection.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Postprocedural iliofemoral angiography is standard for detecting access-site complications after transfemoral transcatheter aortic valve implantation (TF-TAVI).
- The clinical utility of routine angiographic surveillance following TF-TAVI is not well-established.
Purpose of the Study:
- To compare vascular and access-site complications using Vascular Academic Research Consortium-3 (VARC-3) criteria.
- To evaluate routine versus selective postprocedural iliofemoral angiography strategies after TF-TAVI.
Main Methods:
- Retrospective analysis of 1,147 TF-TAVI procedures across two sites with differing angiography strategies.
- Comparison between routine angiography (n=674) and selective angiography based on procedural suspicion (n=473).
Main Results:
- Overall VARC-3 complications were similar between selective (6.6%) and routine (8.0%) strategies.
- Routine angiography identified more minor access-site bleedings (13.9% vs 5.2%), but without significant clinical impact.
- Bleeding complications were lower with selective angiography in adjusted analyses, while overall VARC-3 complications did not differ.
Conclusions:
- Routine angiography detects more minor vascular abnormalities but may be unnecessary for many patients undergoing TF-TAVI.
- Selective angiography guided by clinical suspicion appears to yield comparable clinical outcomes.
- Further prospective randomized studies are required to establish the optimal post-TF-TAVI surveillance strategy.
Background:
Postprocedural iliofemoral angiography is commonly used to detect access-site complications after transfemoral transcatheter aortic valve implantation (TF-TAVI). However, the clinical value of routine angiographic surveillance remains uncertain.
Aims:
To compare vascular and access-site-related complications according to Vascular Academic Research Consortium-3 (VARC-3) criteria associated with routine and selective postprocedural iliofemoral angiography after TF-TAVI.
Methods:
We retrospectively analyzed 1,147 TF-TAVI procedures at 2 sites of a single center with different institutional strategies for postprocedural angiographic assessment. One site routinely performed iliofemoral angiography after TAVI (n = 674), whereas the other applied a selective strategy based on procedural suspicion (n = 473).
Results:
Vascular and access-site complications (VARC-3) were similar between strategies (selective 6.6% vs routine 8.0%; OR: 0.76; 95% CI: 0.48-1.19). Routine angiography detected more access-site bleedings (13.9% vs 5.2%; P < 0.001), without differences in hemoglobin drop, transfusion due to access-site bleeding, or bleeding-related death. Overall vascular reinterventions were comparable (4.2% vs 6.5%; P = 0.095), with more catheter-based interventions in the routine strategy and more surgical/thrombin-based interventions in the selective strategy. In adjusted and inverse probability of treatment weights-weighted analyses, bleeding complications remained lower with the selective strategy, whereas overall VARC-3 complications did not differ. After adjustment using the inverse probability of treatment weights model, the angiography strategy was not associated with acute kidney injury despite higher total contrast in the routine group.
Conclusion:
Routine angiography increases detection of minor vascular abnormalities, while selective angiography guided by clinical suspicion may provide comparable clinical outcomes. Routine postprocedural angiography may be unnecessary in many patients. Prospective randomized studies are needed to determine the optimal surveillance strategy.
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