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. 2025 Dec 15.
doi: 10.1007/s00392-025-02805-2. Online ahead of print.

Ultrasound versus angiographic guided access in transfemoral TAVI: intra-operator evaluation of vascular and bleeding complications

Niklas Lankisch  1 , Gianmarco Iannopollo  1   2 , Oliver Dumpies  1 , Ahmed Abdelhafez  1 , Johannes Rotta Detto Loria  1 , Ines Richter  1 , Hans-Josef Feistritzer  1 , Steffen Desch  1 , Thilo Noack  3 , Holger Thiele  1 , Nicolas Majunke  1 , Mohamed Abdel-Wahab  4
Affiliations

Ultrasound versus angiographic guided access in transfemoral TAVI: intra-operator evaluation of vascular and bleeding complications

Niklas Lankisch et al. Clin Res Cardiol. .

Abstract

Background: Both angiography roadmap (RM) and ultrasound (US) are commonly used to obtain femoral arterial access during transfemoral transcatheter aortic valve implantation (TAVI). In this analysis, we sought to evaluate the effect of implementation of an US-guided approach on vascular and bleeding complications.

Methods: Vascular complications and bleeding at the main access site were compared using 4-year data from two experienced TAVI-operators, who changed their practice from an exclusively RM- to an exclusively US-guided technique for access in transfemoral TAVI.

Results: A total of 1026 patients were analyzed (RM: n = 485, US: n = 541) with a mean age of 80.7 ± 6.3 years; 47.7% were female and 37.1% received a balloon-expandable valve. Main access vascular complications, bleedings, or their composite were lower in the US-group (RM vs. US: 16.1% vs. 8.3%, p < 0.001). US was a protective factor for vascular complications, bleeding and their composite (adjusted odds ratio [OR] 0.51, 95%-confidence interval [CI] 0.33-0.77, p = 0.002; adjusted OR 0.46, 95%-CI 0.28-0.78, p = 0.003; and adjusted OR: 0.47; 95% CI 0.32-0.70, p < 0.001, respectively). Fluoroscopy time (14 [interquartile range (IQR) 11 - 20] min vs. 13 [IQR 10 - 17] min, p < 0.001), contrast use (88 [IQR 69 - 111] ml vs. 84 [IQR 65 - 110] ml, p = 0.049) and procedure time (52 [IQR 44 - 67] min vs. 49 [IQR 41 - 62] min, p = 0.02) were lower in the US-group.

Conclusions: US-guided femoral access was associated with significantly fewer complications compared with RM-guidance, supporting its adoption even among operators experienced with angiographic guidance.

Keywords: Angiography; Roadmap; TAVI; Ultrasound; Vascular access.

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Conflict of interest statement

Declarations. Conflict of interest: MAW reports that his hospital receives speaker’s honoraria and/or consultancy fees on his behalf from Boston Scientific, Abbott and Medtronic. All other authors have no conflicts of interest to declare.

References

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