Iliofemoral Artery Volume Assessment with 3D Computed Tomography and Vascular Complications Risk of Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation

Yoav Hammer Cardiology department, Rabin medical center, Beilinson campus, Israel Sackler School of Medicine, Tel Aviv University, Israel Uri Landes Cardiology department, Rabin medical center, Beilinson campus, Israel Sackler School of Medicine, Tel Aviv University, Israel Oren Zusman Cardiology department, Rabin medical center, Beilinson campus, Israel Sackler School of Medicine, Tel Aviv University, Israel Abid Assali Cardiology department, Rabin medical center, Beilinson campus, Israel Sackler School of Medicine, Tel Aviv University, Israel Katia Orvin Cardiology department, Rabin medical center, Beilinson campus, Israel Sackler School of Medicine, Tel Aviv University, Israel Amos Levi Cardiology department, Rabin medical center, Beilinson campus, Israel Sackler School of Medicine, Tel Aviv University, Israel Hanna Vaknin-Assa Cardiology department, Rabin medical center, Beilinson campus, Israel Sackler School of Medicine, Tel Aviv University, Israel Yaron Shapira Cardiology department, Rabin medical center, Beilinson campus, Israel Sackler School of Medicine, Tel Aviv University, Israel Pablo Codner Cardiology department, Rabin medical center, Beilinson campus, Israel Sackler School of Medicine, Tel Aviv University, Israel Ram Sharoni Cardiology department, Rabin medical center, Beilinson campus, Israel Sackler School of Medicine, Tel Aviv University, Israel Alexander Sagie Cardiology department, Rabin medical center, Beilinson campus, Israel Sackler School of Medicine, Tel Aviv University, Israel Ashraf Hamdan Cardiology department, Rabin medical center, Beilinson campus, Israel Sackler School of Medicine, Tel Aviv University, Israel Ran Kornowski Cardiology department, Rabin medical center, Beilinson campus, Israel Sackler School of Medicine, Tel Aviv University, Israel

Background: Although effective and safe, transcatheter aortic valve implantation (TAVI) carries a risk for complications, the most frequent being vascular complication (VC) at the access site. Minimal vessel diameter, tortuosity and calcification are being used prior to TAVI for VC risk assessment. We examined whether Iliofemoral artery volume (IFV) assessments with 3-dimensional (D) computed tomography (CT) could be a more accurate screening alternative.

Methods: From our prospective registry of 560 TAVI patients, we identified those who underwent transfemoral TAVI and had VC, and performed nearest neighbor 1:1 matching with patients without VC with matching for age, sex, TAVI year, transcatheter valve size and type, closure device and peripheral vascular disease. IFV, vessel diameter, tortuosity, and calcification were measured and their diagnostic performance was assessed and compared between patients with and without VC.

Results: The final analysis included 45 patients with VC and 45 paired patients without VC. The two groups were well balanced. For all patients, IFV was 9.5 ±4.9 ml mean, 8.65 (IQR 5.5) ml median. IFV was lower in patients with VC compare to patients without VC: 7.10 (IQR 5.4 – 9.0) vs. 10.10 (IQR 8.3-13.3),p < 0.001 and showed a dose response relation between IFV and VC risk. Minimal vessel diameter and VC risk had a borderline association (p=0.062), while tortuosity (p=0.609) and calcification (p=0.571) had no association with VC risk. Compared with other measurements, IFV had the most favorable receiver operating curve for the prediction of VC, with an area under the curve (AUC) of 0.78.

Conclusion: Contrast enhanced 3DCT assessment has shown that low IFV was associated with increased risk of VC in patients undergoing TAVI. Measuring IFV with 3DCT may be a strong screening tool for the occurrence of VC in transfemoral TAVI. Further larger, prospective studies are required to validate this new tool.

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Presentation

Yoav Hammer