Utilization of Peripheral Vascular Stent-Grafts in the Cardiac Catheterization Laboratory: Percutaneous Management of Vascular Complications

Background: We have adopted a strategy of implanting peripheral vascular stent-grafts for percutaneous management of access site bleeding following transcatheter aortic valve implantation (TAVI). This treatment has been used successfully in 136 patients undergoing TAVI who had access site complications. We have subsequently expanded the indications for stent-graft implantation for treating other vascular complications in our interventional cardiology practice.

Methods: Retrospective review of a prospective cardiac catheterization laboratory registry. All cases of stent-graft implantation for treatment of vascular complications in patients not undergoing TAVI were recorded.

Results: Indications for stent-graft implantation included: 1) Femoral artery pseudoaneurysms: Two inoperable patients developed large pseudoaneurysms following coronary angioplasty, which were unresponsive to local compression and thrombin injection. Stent-graft implantation was followed by resolution of flow into the pseudoaneurysms and resorption of the hematomas. 2) Ruptured aneurysm in a degenerated saphenous vein coronary bypass graft (SVG): A patient sustained cardiogenic shock following rupture of a SVG aneurysm, which resulted in cardiac tamponade. Immediate delivery of a stent-graft sealed the aneurysm.

Conclusions: Peripheral vascular stent-grafts may play an important role in percutaneous management of various vascular emergencies in the cardiac catherization laboratory.