St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
JACC Cardiovasc Interv. 2013 Aug;6(8):767-76. doi: 10.1016/j.jcin.2013.05.004.
The interventional cardiologist must be able to recognize and manage potential vascular complications. Iliofemoral complications are the most frequent vascular complications in transfemoral transcatheter aortic valve implantation. Small vessel dimensions, moderate or severe calcification, and center experience are the major predictors. The traditional treatment for injured arteries has been surgical reconstruction, but endovascular techniques may allow for less invasive but effective management of arterial injuries. Dissection may be treated with prolonged balloon inflation or deployment of a self-expanding or balloon-expandable stent or a surgical graft. Iliofemoral rupture is a serious complication that may lead to retroperitoneal bleeding that can be unrecognized. Rapid insertion of a dilator or sheath or an occlusive balloon is used to achieve hemostasis. Prolonged balloon inflation or implantation of a covered stent or surgical repair should then be considered. Treatment options for failed percutaneous closure include prolonged manual compression, balloon angioplasty, stent implantation, and surgery. Aortic complications are rare, but serious complications are associated with a high mortality rate, even if emergent surgery is performed. There are specific vascular complications associated with alternative access routes such as transapical and transaxillary and direct aortic access.
介入心脏病学家必须能够识别和处理潜在的血管并发症。经股动脉经导管主动脉瓣植入术中，髂股血管并发症最为常见。小血管尺寸、中度或重度钙化以及中心经验是主要预测因素。传统的损伤动脉治疗方法是手术重建，但血管内技术可能允许对动脉损伤进行侵入性较小但有效的管理。夹层可通过长时间球囊扩张或自膨式或球囊扩张支架或手术移植物的放置来治疗。髂股动脉破裂是一种严重的并发症，可能导致腹膜后出血而未被识别。快速插入扩张器或护套或闭塞球囊用于实现止血。然后应考虑长时间球囊扩张或植入覆膜支架或手术修复。经皮闭合失败的治疗选择包括长时间手动压迫、球囊血管成形术、支架植入术和手术。主动脉并发症很少见，但严重并发症与高死亡率相关，即使进行紧急手术也是如此。还有一些与替代入路相关的特定血管并发症，如经心尖和经腋动脉以及直接主动脉入路。
