Dencker Ditte, Taudorf Mikkel, Luk N H Vincent, Nielsen Michael B, Kofoed Klaus F, Schroeder Torben V, Søndergaard Lars, Lönn Lars, De Backer Ole
Department of Radiology, Rigshospitalet, Copenhagen, Denmark.
Department of Radiology, Rigshospitalet, Copenhagen, Denmark.
Am J Cardiol. 2016 Oct 15;118(8):1244-1250. doi: 10.1016/j.amjcard.2016.07.045. Epub 2016 Jul 29.
Vascular access and closure remain a challenge in transcatheter aortic valve replacement (TAVR). This single-center study aimed to report the incidence, predictive factors, and clinical outcomes of access-related vascular injury and subsequent vascular intervention. During a 30-month period, 365 patients underwent TAVR and 333 patients (94%) were treated by true percutaneous transfemoral approach. Of this latter group, 83 patients (25%) had an access-related vascular injury that was managed by the use of a covered self-expanding stent (n = 49), balloon angioplasty (n = 33), or by surgical intervention (n = 1). In 16 patients (5%), the vascular injury was classified as a major vascular complication. Absence of a preprocedural computed tomography angiography (CTA) of the iliofemoral arteries (OR 2.04, p = 0.007) and female gender (OR 2.18, p = 0.004) were independent predictors of the need for access-related vascular intervention. In addition, a high sheath/common femoral artery ratio as measured on preoperative CTA was associated with a higher rate of post-TAVR vascular intervention. The radiation dose, iodine contrast volume, transfusion need, length of hospitalization, and 30-day mortality were not significantly different between patients with versus without access-related vascular intervention. In conclusion, access-related vascular intervention in patients who underwent transfemoral-TAVR is not uncommon. Female gender and a high sheath/common femoral artery ratio are risk factors for access-related vascular injury, whereas preprocedural planning with CTA of the access vessels may reduce the risk of vascular injury. Importantly, most access-related vascular injuries may be treated by percutaneous techniques with similar clinical outcomes to patients without vascular injuries.
在经导管主动脉瓣置换术（TAVR）中，血管通路的建立与闭合仍然是一项挑战。本单中心研究旨在报告与血管通路相关的血管损伤及后续血管介入治疗的发生率、预测因素和临床结局。在30个月的时间里，365例患者接受了TAVR治疗，其中333例患者（94%）采用真正的经皮股动脉入路进行治疗。在这后一组患者中，83例患者（25%）发生了与血管通路相关的血管损伤，通过使用覆膜自膨式支架（n = 49）、球囊血管成形术（n = 33）或手术干预（n = 1）进行处理。16例患者（5%）的血管损伤被归类为严重血管并发症。术前未进行髂股动脉计算机断层扫描血管造影（CTA）（OR 2.04，p = 0.007）和女性性别（OR 2.18，p = 0.004）是与血管通路相关的血管介入治疗需求的独立预测因素。此外，术前CTA测量的高鞘管/股总动脉比值与TAVR术后血管介入治疗的发生率较高相关。接受与未接受与血管通路相关的血管介入治疗的患者之间，辐射剂量、碘造影剂用量、输血需求、住院时间和30天死亡率并无显著差异。总之，接受经股动脉TAVR治疗的患者中与血管通路相关的血管介入治疗并不罕见。女性性别和高鞘管/股总动脉比值是与血管通路相关的血管损伤的危险因素，而术前对血管通路进行CTA规划可能会降低血管损伤的风险。重要的是，大多数与血管通路相关的血管损伤可通过经皮技术进行治疗，其临床结局与未发生血管损伤的患者相似。
