Safety and Efficacy of Using the Viabahn Endoprosthesis for Percutaneous Treatment of Vascular Access Complications After Transfemoral Aortic Valve Implantation

• Published in: The American journal of cardiology 2015-04, Vol.115 (8), p.1123-1129
• Main Authors: De Backer, Ole, MD, PhD, Arnous, Samer, MD, Sandholt, Benjamin, MD, Brooks, Matthew, MD, Biasco, Luigi, MD, Franzen, Olaf, MD, Lönn, Lars, MD, PhD, Bech, Bo, MD, PhD, Søndergaard, Lars, MD, DMSc
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Angiography; Aortic Valve Stenosis - surgery; Arterial Occlusive Diseases - diagnosis; Arterial Occlusive Diseases - etiology; Arterial Occlusive Diseases - surgery; Blood transfusions; Blood Vessel Prosthesis; Body mass index; Cardiac Catheterization - adverse effects; Cardiology; Cardiovascular; Catheters; Diabetes; Endovascular Procedures - methods; Female; Femoral Artery; Follow-Up Studies; Heart attacks; Hospitalization; Humans; Intensive care; Male; Medical imaging; Mortality; Patients; Prosthesis Design; Stents; Studies; Time Factors; Tomography, X-Ray Computed; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - methods; Treatment Outcome; Variables
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2015.01.547

Vascular access complications (VACs) remain one of the biggest challenges when performing transcatheter aortic valve implantation (TAVI). This study aimed to investigate the short- and medium-term safety and efficacy of the Viabahn endoprosthesis (Gore, Flagstaff, AZ) when used to treat TAVI-induced vascular injury. Over a 40-month period, 354 patients underwent true percutaneous transfemoral (TF)-TAVI using a CoreValve and Prostar-XL closure system; this was our study population. A VAC leading to acute intervention occurred in 72 patients (20.3%) - of these, 18 were managed by balloon angioplasty, 48 were treated by Viabahn stenting (technical success rate 98%), and 6 needed surgical intervention. Overall, this approach resulted in a major VAC rate of 3.1% (n = 11) in our study cohort. Length of hospitalization and 30-day mortality rates were comparable in patients with a VAC treated by Viabahn stenting versus patients without vascular complications. Two patients (4.5%) presented with new-onset claudication; one of them had the stent implanted covering the deep femoral artery (DFA). At medium-term follow-up (median 372 days; range 55 to 978 days) duplex ultrasound showed 100% patency of the Viabahn endoprostheses with no signs of stent fracture or in-stent stenosis/occlusion. In conclusion, the use of self-expanding covered stents is safe and effective in case of TF-TAVI–induced vascular injury, with good short- and medium-term outcomes. Importantly, coverage of the DFA should be avoided. If confirmed by long-term (>5 years) follow-up studies, this strategy for treating TAVI-induced VAC may be used routinely in high-risk patients.