Tips and tricks in the prevention and management of vascular complications in TAVI

• Published in: Cirugía cardiovascular 2024-09
• Main Authors: Tommasino, Antonella, Sirignano, Pasqualino, Dell’Aquila, Federico, Fiorentini, Vincenzo, Casenghi, Matteo, Giovannelli, Francesca, Rigattieri, Stefano, Berni, Andrea, Taurino, Maurizio, Barbato, Emanuele
• Format: Article
• Language: English
• Subjects: Acceso guiado por ultrasonido; Acceso por arteria radial; Complicación vascular; Equipo cardiovascular; Heart-team; Implante de válvula aórtica transcatéter; Radial artery access; Transcatheter aortic valve implantation; Ultrasound-guided access; Vascular complication
• ISSN: 1134-0096
• DOI: 10.1016/j.circv.2024.09.001

Transcatheter aortic valve implantation (TAVI) has become a standard treatment for severe aortic stenosis, especially in elderly patients or those considered high-risk for surgery. Despite its increasing success, TAVI still presents challenges, particularly in the management of access site. Advances in procedure planning, device miniaturization and operator experience have mitigated these issues, but vascular complications are still common. The transfemoral approach is the most common for TAVI, although it varies widely depending on operator experience and center protocols, ranging from surgical to fully percutaneous methods. Minimally invasive techniques are increasingly favored to improve the results of the procedure. Effective management of access site complications is critical and requires careful pre-procedure planning and skilled intervention. Recent developments in ultrasound-guided access and the refinement of vascular closure devices have shown promise in reducing complications. It has also been shown that radial access as an axillary approach has a lower complication rate compared to contralateral femoral access. The integration of new devices and techniques, such as the less invasive approach, will further improve patient outcomes. This review emphasizes the importance of a comprehensive, multidisciplinary approach to TAVI and highlights the need for continued innovation and collaboration to further reduce vascular complications and improve the safety and efficacy of the procedure. As TAVI indications expand to younger populations, refinement of access management strategies and incorporation of advanced imaging and predictive tools will be critical to optimizing patient care and outcomes. La implantación de válvula aórtica transcatéter (TAVI) se ha convertido en un tratamiento estándar para la estenosis aórtica severa, especialmente en pacientes ancianos o aquellos considerados de alto riesgo para cirugía. A pesar de su éxito creciente, el TAVI todavía presenta desafíos, particularmente en la gestión del sitio de acceso. Los avances en la planificación del procedimiento, la miniaturización de dispositivos y la experiencia del operador han mitigado estos problemas, pero las complicaciones vasculares siguen siendo comunes. El abordaje transfemoral es el más común para el TAVI, aunque varía ampliamente dependiendo de la experiencia del operador y los protocolos del centro, que van desde métodos quirúrgicos hasta completamente percutáneos. Las técni