Background: Transcatheter aortic valve implantation (TAVI) is commonly performed in patients with severe symptomatic aortic stenosis, usually via transfemoral vascular access. Access-site bleeding is a common complication of TAVI and is associated with increased morbidity and mortality. Percutaneous ileofemoral stent-graft implantation enables intra-procedural control of bleeding, however there is only anecdotal data regarding the safety and efficacy of this approach.
Methods: From our prospective institutional TAVI registry we identified patients who had undergone ileofemoral stent-graft implantation during the procedure. Clinical follow-up was performed from a computerized database and planned TAVI clinic follow-up visits.
Results: Of 141 TAVI procedures performed at our institute over a 4 year period, 132 (94%) cases were performed via transfemoral vascular access. Closure of the femoral artery puncture site was performed with the Prostar suture device. Angiography was routinely performed following sheath removal for identification of bleeding. Persistent ileofemoral bleeding was identified in 16 (12%) patients who had undergone transfemoral TAVI and was treated with implantation of 19 stent-grafts (17 self-expanding and 2 balloon-expandable). In 14 patients bleeding was due to failure of the Prostar closure device and in 2 patients it was due to iliac artery trauma. Stenting was confined to the common femoral artery in 10 patients and included the external iliac artery in 4 patients. Mean stent diameter was 8.0±0.6 mm and mean cumulative stent length was 80±42 mm. Mean patient age was 83±5 years and 10 patients (62%) were female. Bleeding was successfully controlled in all cases without any in-hospital ipsilateral vascular complications. During a mean follow-up period of 533±421 days (range: 4-1153) no vascular complications were reported and no additional vascular interventions were required.
Conclusions: Ileofemoral stent-graft implantation effectively controlled persistent bleeding following TAVI. No local vascular complications were detected during medium-term follow-up.
