Safety of Selective and Routine Femoral Access Angiography Post-Transcatheter Aortic Valve Implantation

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.