Retrograde Femoral Artery Stent-Graft Implantation for Treatment of Access-site Bleeding Following Transcatheter Aortic Valve Implantation
| Autor: | Hussein, Sliman, Avinoam, Shiran, Dallit, Mannheim, Eyal, Avraham, Ron, Karmeli, Nader, Khader, Barak, Zafrir, Ronen, Rubinshtein, Ronen, Jaffe |
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| Rok vydání: | 2019 |
| Předmět: |
Aged
80 and over Male Aortic Valve Stenosis Postoperative Hemorrhage Vascular System Injuries Hemostasis Surgical Femoral Artery Transcatheter Aortic Valve Replacement Outcome and Process Assessment Health Care Aortic Valve Heart Valve Prosthesis Catheterization Peripheral Feasibility Studies Humans Female Intraoperative Complications Aged |
| Zdroj: | The Israel Medical Association journal : IMAJ. 21(5) |
| ISSN: | 1565-1088 |
| Popis: | Access-site bleeding is a common complication of transfemoral transcatheter aortic valve implantation (TAVI). Percutaneous stent-graft implantation within the femoral artery may achieve hemostasis and avert the need for more invasive surgical vascular repair; however, failure to advance a guidewire antegradely via the injured vessel may preclude stent delivery. While retrograde stent-graft delivery from the distal vasculature may potentially enable percutaneous control of bleeding, this approach has not been reported.To assess the feasibility of a retrograde approach for stent-graft implantation in the treatment of access-site bleeding following transfemoral TAVI.A prospective TAVI registry was analyzed. Of 349 patients who underwent TAVI, transfemoral access was used in 332 (95%). Access-site injury requiring stent-graft implantation occurred in 56 (17%). In four patients (7%), antegrade wiring across the site of vascular injury was not possible and a retrograde approach for stent delivery was used.Distal vascular access was achieved via the superficial femoral or profunda artery. Retrograde advancement of a polymer-coated 0.035" wire to the abdominal aorta, followed by stent-graft delivery to the common femoral artery, achieved hemostasis in all cases. During a median (interquartile range) follow-up period of 198 (618) days (range 46-2455) there were no deaths and no patient required additional vascular interventions.A retrograde approach for stent-graft delivery is feasible and allows percutaneous treatment of a common femoral artery injury following TAVI in patients who are not suitable for the conventional antegrade approach. |
| Databáze: | OpenAIRE |
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