- 作者：Stefan Stortecky ; MD鈦?/sup> ; Peter Wenaweser ; MD鈦?/sup> ; peter.wenaweser@insel.ch ; Nicolas Diehm ; MD&dagger ; ; Thomas Pilgrim ; MD鈦?/sup> ; Christoph Huber ; MD&Dagger ; ; Andrea Bianca Rosskopf ; MD§ ; ; Ahmed A. Khattab ; MD鈦?/sup> ; Lutz Buellesfeld ; MD鈦?/sup> ; Steffen Gloekler ; MD鈦?/sup> ; Balthasar Eberle ; MD鈭?/sup> ; Jü ; rg Schmidli ; MD&Dagger ; ; Thierry Carrel ; MD&Dagger ; ; Bernhard Meier ; MD鈦?/sup> ; Stephan Windecker ; MD鈦?/sup>
- 关键词：covered stent graft ; percutaneous access ; transcatheter aortic valve implantation ; vascular complication
- 刊名：JACC ; Cardiovascular Interventions
- 出版年：2012
- 期刊代码：pca198_19368798
- 类别：med
- 出版时间：May, 2012
- 卷：5
- 期：5
- 页码：515-524
- 文件大小：1621 K
Objectives
This study sought to investigate the feasibility and safety of percutaneous management of vascular complications after transcatheter aortic valve implantation (TAVI).Background
Vascular complications after TAVI are frequent and outcomes after percutaneous management of these adverse events not well established.
Methods
Between August 2007 and July 2010, 149 patients underwent transfemoral TAVI using a percutaneous approach. We compared outcomes of patients undergoing percutaneous management of vascular complications with patients free from vascular complications and performed duplex ultrasonography, fluoroscopy, and multislice computed tomography during follow-up.
Results
A total of 27 patients (18%) experienced vascular complications consisting of incomplete arteriotomy closure (n = 19, 70%), dissection (n = 3, 11%), arterial perforation (n = 3, 11%), arterial occlusion (n = 1, 4%), and pseudoaneurysm (n = 1, 4%). Percutaneous stent graft implantation was successful in 21 of 23 (91%) patients, whereas 2 patients were treated by manual compression, 2 patients underwent urgent surgery, and 2 patients required delayed surgery. Rates of major adverse cardiac events at 30 days were similar among patients undergoing percutaneous management of vascular complications and those without vascular complications (9%vs. 8%, p = 1.00). After a median follow-up of 10.9 months, imaging showed no evidence of hemodynamically significant stenosis (mean peak velocity ratio: 1.2 卤 0.4). Stent fractures were observed in 4 stents (22%, type I [6%], type II [16%]) and were clinically silent in all cases.
Conclusions
Vascular complications after TAVI can be treated percutaneously as a bailout procedure with a high rate of technical success, and clinical outcomes are comparable to patients without vascular complications. Stent patency is high during follow-up, although stent fractures require careful scrutiny.