Long-Term Outcomes of Ilio-Femoral Artery Stents Following Trans-Femoral Aortic Valve Replacement

Yoni Grossman Leviev Heart Center, Sheba Medical Center, Israel Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Daniel Siverberg Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Vascular Surgery Department, Sheba Medical Center, Israel Anat Berkovitch Leviev Heart Center, Sheba Medical Center, Israel Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Fernando Chernomordik Leviev Heart Center, Sheba Medical Center, Israel Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Arwa Younis Leviev Heart Center, Sheba Medical Center, Israel Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Elad Asher Leviev Heart Center, Sheba Medical Center, Israel Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Israel Barbash Leviev Heart Center, Sheba Medical Center, Israel Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Moshe Halak Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Vascular Surgery Department, Sheba Medical Center, Israel Victor Guetta Leviev Heart Center, Sheba Medical Center, Israel Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Amit Segev Leviev Heart Center, Sheba Medical Center, Israel Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Paul Fefer Leviev Heart Center, Sheba Medical Center, Israel Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

Objectives: To assess the long term outcomes of iliofemoral stents after Trans-catheter Aortic Valve Replacement (TAVR).

Background: Vascular access site and access-related complications present a common problem during trans-femoral TAVR. Although stent placement in the common femoral artery (CFA) is a commonly used solution for such complications, its long term safety and efficacy are not well defined.

Methods: From a single center cohort of 648 patients who underwent TAVR at Sheba Medical Center in Israel, 90 patients suffered an access-related complication requiring intervention. Of these, 56 patients underwent common femoral artery (CFA) stent insertion. Patients were assessed by history and physical examination, underwent follow-up duplex ultrasound velocity evaluation of the common femoral stent and a bilateral Doppler ultrasound arterial exam, including Ankle-brachial index (ABI) measurement.

Results: Mean follow up time was 676 days. None of the 56 patients needed a vascular intervention of the affected limb, and none suffered from a relevant limb claudication. There was no difference between pre-procedural and post procedural ABI values (1.2±0.14 and 1.19±0.24, respectively), and only one patient demonstrated a significant decrease in the ABI associated with medium severity CFA stent stenosis that did not require further intervention. There were no stent fractures.

Conclusions: Ilio-femoral stent insertion is a safe and efficacious treatment for vascular access site and access-related complications during trans-femoral TAVR.

Yoni Grossman

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