Safety and efficacy of using the Viabahn endoprosthesis for percutaneous treatment of vascular access complications after transfemoral aortic valve implantation
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Safety and efficacy of using the Viabahn endoprosthesis for percutaneous treatment of vascular access complications after transfemoral aortic valve implantation. / De Backer, Ole; Arnous, Samer; Sandholt, Benjamin; Brooks, Matthew; Biasco, Luigi; Franzen, Olaf; Lönn, Lars; Bech, Bo; Søndergaard, Lars.
I: American Journal of Cardiology, Bind 115, Nr. 8, 15.04.2015, s. 1123-9.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Safety and efficacy of using the Viabahn endoprosthesis for percutaneous treatment of vascular access complications after transfemoral aortic valve implantation
AU - De Backer, Ole
AU - Arnous, Samer
AU - Sandholt, Benjamin
AU - Brooks, Matthew
AU - Biasco, Luigi
AU - Franzen, Olaf
AU - Lönn, Lars
AU - Bech, Bo
AU - Søndergaard, Lars
N1 - Copyright © 2015 Elsevier Inc. All rights reserved.
PY - 2015/4/15
Y1 - 2015/4/15
N2 - Vascular access complications (VACs) remain one of the biggest challenges when performing transcatheter aortic valve implantation (TAVI). This study aimed to investigate the short- and medium-term safety and efficacy of the Viabahn endoprosthesis (Gore, Flagstaff, AZ) when used to treat TAVI-induced vascular injury. Over a 40-month period, 354 patients underwent true percutaneous transfemoral (TF)-TAVI using a CoreValve and Prostar-XL closure system; this was our study population. A VAC leading to acute intervention occurred in 72 patients (20.3%) - of these, 18 were managed by balloon angioplasty, 48 were treated by Viabahn stenting (technical success rate 98%), and 6 needed surgical intervention. Overall, this approach resulted in a major VAC rate of 3.1% (n = 11) in our study cohort. Length of hospitalization and 30-day mortality rates were comparable in patients with a VAC treated by Viabahn stenting versus patients without vascular complications. Two patients (4.5%) presented with new-onset claudication; one of them had the stent implanted covering the deep femoral artery (DFA). At medium-term follow-up (median 372 days; range 55 to 978 days) duplex ultrasound showed 100% patency of the Viabahn endoprostheses with no signs of stent fracture or in-stent stenosis/occlusion. In conclusion, the use of self-expanding covered stents is safe and effective in case of TF-TAVI-induced vascular injury, with good short- and medium-term outcomes. Importantly, coverage of the DFA should be avoided. If confirmed by long-term (>5 years) follow-up studies, this strategy for treating TAVI-induced VAC may be used routinely in high-risk patients.
AB - Vascular access complications (VACs) remain one of the biggest challenges when performing transcatheter aortic valve implantation (TAVI). This study aimed to investigate the short- and medium-term safety and efficacy of the Viabahn endoprosthesis (Gore, Flagstaff, AZ) when used to treat TAVI-induced vascular injury. Over a 40-month period, 354 patients underwent true percutaneous transfemoral (TF)-TAVI using a CoreValve and Prostar-XL closure system; this was our study population. A VAC leading to acute intervention occurred in 72 patients (20.3%) - of these, 18 were managed by balloon angioplasty, 48 were treated by Viabahn stenting (technical success rate 98%), and 6 needed surgical intervention. Overall, this approach resulted in a major VAC rate of 3.1% (n = 11) in our study cohort. Length of hospitalization and 30-day mortality rates were comparable in patients with a VAC treated by Viabahn stenting versus patients without vascular complications. Two patients (4.5%) presented with new-onset claudication; one of them had the stent implanted covering the deep femoral artery (DFA). At medium-term follow-up (median 372 days; range 55 to 978 days) duplex ultrasound showed 100% patency of the Viabahn endoprostheses with no signs of stent fracture or in-stent stenosis/occlusion. In conclusion, the use of self-expanding covered stents is safe and effective in case of TF-TAVI-induced vascular injury, with good short- and medium-term outcomes. Importantly, coverage of the DFA should be avoided. If confirmed by long-term (>5 years) follow-up studies, this strategy for treating TAVI-induced VAC may be used routinely in high-risk patients.
KW - Aged
KW - Aged, 80 and over
KW - Angiography
KW - Aortic Valve Stenosis
KW - Arterial Occlusive Diseases
KW - Blood Vessel Prosthesis
KW - Cardiac Catheterization
KW - Endovascular Procedures
KW - Female
KW - Femoral Artery
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Prosthesis Design
KW - Time Factors
KW - Tomography, X-Ray Computed
KW - Transcatheter Aortic Valve Replacement
KW - Treatment Outcome
U2 - 10.1016/j.amjcard.2015.01.547
DO - 10.1016/j.amjcard.2015.01.547
M3 - Journal article
C2 - 25728645
VL - 115
SP - 1123
EP - 1129
JO - Am. J. Cardiol.
JF - Am. J. Cardiol.
SN - 0002-9149
IS - 8
ER -
ID: 162034237