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Review
. 2021 Oct 28;10(21):5046.
doi: 10.3390/jcm10215046.

Vascular Complications in TAVR: Incidence, Clinical Impact, and Management

Markus Mach  1 , Sercan Okutucu  2 , Tillmann Kerbel  1 , Aref Arjomand  3 , Sefik Gorkem Fatihoglu  4 , Paul Werner  1 , Paul Simon  1 , Martin Andreas  1
Affiliations
Review

Vascular Complications in TAVR: Incidence, Clinical Impact, and Management

Markus Mach et al. J Clin Med. .

Abstract

Transcatheter aortic valve replacement (TAVR) has replaced surgical aortic valve replacement as the new gold standard in elderly patients with severe aortic valve stenosis. However, alongside this novel approach, new complications emerged that require swift diagnosis and adequate management. Vascular access marks the first step in a TAVR procedure. There are several possible access sites available for TAVR, including the transfemoral approach as well as transaxillary/subclavian, transcarotid, transapical, and transcaval. Most cases are primarily performed through a transfemoral approach, while other access routes are mainly conducted in patients not suitable for transfemoral TAVR. As vascular access is achieved primarily by large bore sheaths, vascular complications are one of the major concerns during TAVR. With rising numbers of TAVR being performed, the focus on prevention and successful management of vascular complications will be of paramount importance to lower morbidity and mortality of the procedures. Herein, we aimed to review the most common vascular complications associated with TAVR and summarize their diagnosis, management, and prevention of vascular complications in TAVR.

Keywords: TAVI; TAVR; aortic valve; complications; transcatheter; transfemoral; vascular.

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Conflict of interest statement

M. Mach has received a research grant from Edwards Lifesciences, JenaValve, and Symetis. M. Andreas is a proctor for Edwards Lifesciences and Abbott Laboratories and an adviser to Medtronic. All other authors have reported that they have no relationships relevant to the content.

Figures

Figure 1
Figure 1
(A) Fluoroscopic and (B) schematic illustration of the ideal common femoral artery puncture site.
Figure 2
Figure 2
(A,B) Fluoroscopic evidence of dissection in the ascending aorta during THV deployment with red arrows indicating the dissection flap.
Figure 3
Figure 3
(A) Sonographic, (B) computer-tomographic, and (C) fluoroscopic evidence of pseudoaneurysm formation (PSA) with a short, broad neck (N) in the common femoral artery (CFA) after transfemoral THV implantation. (D) Pseudoaneurysm exclusion by endovascular implantation of a balloon-expandable covered stent graft (8 × 50 mm Gore® Viabahn®).
Figure 4
Figure 4
(A) Vascular closure device failure after TAVI with consecutive stenosis and bleeding of the right common femoral artery. (B) Endovascular treatment of the right common femoral artery with a self-expanding covered stent graft (9 × 50 mm Gore® Viabahn®). (C) Control angiography shows unobstructed outflow without extravasation.
See this image and copyright information in PMC

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