Background: Transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis is usually performed 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 without need for surgical repair, however the safety and efficacy of this approach are unknown.
Methods: From our prospective institutional TAVI registry we identified patients who had undergone intra-procedural ileofemoral stent-graft implantation. Follow-up was performed from a computerized database and TAVI clinic visits.
Results: Of 192 TAVI procedures performed at our institute, 181 (94%) cases were performed via transfemoral access. Closure of the femoral artery puncture site was performed with the Prostar device (Abbott Laboratories). Angiography was routinely performed following sheath removal for identification of bleeding. Persistent ileofemoral bleeding was identified in 29 (16%) patients and was treated with implantation of 34 stent-grafts. Mean patient age was 81±7 years and 18 patients (62%) were female. In 32 patients bleeding was due to failure of the Prostar device and in 2 patients it was due to iliac artery trauma. Stenting was confined to the common femoral artery in 23 patients and included the external iliac artery in 6 patients. Bleeding was successfully controlled in all cases. A single peri-procedural complication occurred in a morbidly obese woman with severe retroperitoneal hemorrhage in whom the stent-graft was implanted across the origin of the superficial femoral artery, who developed mild ischemia in the right leg with perfusion of the distal limb via collaterals. During follow-up of 536±44 days (range: 18-1517) no additional vascular complications occurred and no vascular interventions were required.
Conclusions: Ileofemoral stent-graft implantation provided effective percutaneous control of severe access site bleeding following transfemoral TAVI with minimal peri-procedural complications. Mid-term safety of ileofemoral stent-graft implantation was excellent.
