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Review
. 2016 Sep-Oct;68(5):724-731.
doi: 10.1016/j.ihj.2015.11.024. Epub 2016 Jan 12.

Vascular complications post-transcatheter aortic valve procedures

Ashvarya Mangla  1 , Saurabh Gupta  2
Affiliations
Review

Vascular complications post-transcatheter aortic valve procedures

Ashvarya Mangla et al. Indian Heart J. 2016 Sep-Oct.

Abstract

Transcatheter aortic valve replacement (TAVR) has rapidly emerged as the standard of care for severe symptomatic aortic stenosis in patients whose comorbidities put them at prohibitive risk for surgical aortic valve replacement (SAVR). Several trials have demonstrated superior outcomes with TAVR compared to medical management alone. TAVR has also shown favorable outcomes in patients at high risk for SAVR. TAVR can be associated with significant vascular complications, which adversely impact outcomes, and operators should be cognizant of their early recognition and appropriate management. In this article, we review the major vascular complications associated with TAVR, along with optimal prevention and management strategies.

Keywords: Endovascular repair; Percutaneous procedures; Preprocedural imaging; Transcatheter aortic valve replacement/implantation; Vascular complications.

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Figures

Fig. 1
Fig. 1
Impact of vascular complications on 30-day mortality. Mortality was consistently higher in those with vascular complications [16.9% (red dotted line) in those with and 6.6% (blue dotted) without].
Fig. 2
Fig. 2
A comparison of mean hospital length of stay in patients without (blue) and with (red) major vascular complications.
Fig. 3
Fig. 3
Complication rates with increasing operator experience (vascular complications, major bleeding, and unplanned surgery declined as operators gained experience).
Fig. 4
Fig. 4
Postprocedure invasive angiography showing external iliac artery dissection with thrombus (green arrow).
Fig. 5
Fig. 5
External iliac artery postdeployment of self-expanding stent for management of arterial dissection showing resolution of dissection and return of normal flow. (Green arrow points to the site of previous dissection.)
Fig. 6
Fig. 6
Postprocedure retrograde angiogram showing contrast extravasation from right external iliac artery, which is diagnostic of perforation and rupture (red arrow). An occlusive balloon is noted proximal to the site of vessel injury (green arrow).
See this image and copyright information in PMC

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