Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Division of Vascular Surgery, University of British Columbia, Vancouver, BC, Canada.
Ann Vasc Surg. 2021 Jul;74:258-263. doi: 10.1016/j.avsg.2020.12.032. Epub 2021 Feb 4.
Transcatheter aortic valve implantation (TAVI) procedures have revolutionized the treatment of aortic stenosis. However, due to large sheaths, improperly deployed closure devices, and the comorbidities and challenges innate to this population, vascular access complications can be devastating. The objective of this study is to evaluate vascular access complications in one of the largest TAVI sites in North America.
This was a retrospective single center review between January 2014 and December 2018 of vascular access complications necessitating operative intervention by vascular surgery. Patient demographics and preoperative comorbidities were collected. Type of vascular access complication, types of repair, closure device used, and postoperative outcomes were analyzed.
A total of 37 cases out of a total of 985 TAVI procedures were identified. TAVI was carried out in the operating suite (70%) or the catheterization lab (30%). Consults to vascular surgery were requested intraoperatively (60%), immediately postoperative (14%), later in the day of the TAVI (20%), and on postoperative day 1 (6%). The location of injury included common femoral artery (49%), superficial femoral artery (11%) and external iliac artery (41%), with some cases injuring multiple vessels. Closure devices were found in the subcutaneous tissue (26%), anterior wall (37%), posterior wall (11%), intra-arterial (11%), closing the anterior to the posterior wall (16%), and in the inguinal ligament (5%). Injuries included tears (11%), dissections (38%), and vessel rupture (19%). The majority of repairs were done primarily (64%), with patch (28%) and bypass (8%) less frequently. Four patients died perioperatively (11%), 2 from hemorrhage, 1 from cardiac arrest, and 1 from progressive respiratory disease.
Access complications during TAVI procedures predispose complex patients to increased risk of morbidity and mortality. Careful patient selection, proper access techniques, and performing high risk patients in the operating suite with vascular surgery are fundamental in minimizing complications.
经导管主动脉瓣植入术（TAVI）已经彻底改变了主动脉瓣狭窄的治疗方法。然而，由于鞘管较大、封堵装置放置不当以及该人群固有的合并症和挑战，血管入路并发症可能是毁灭性的。本研究的目的是评估北美的一个最大的 TAVI 中心之一的血管入路并发症。
这是一项回顾性的单中心研究，纳入了 2014 年 1 月至 2018 年 12 月期间因血管外科手术干预而需要手术治疗的血管入路并发症患者。收集患者的人口统计学和术前合并症数据。分析血管入路并发症的类型、修复类型、使用的封堵装置以及术后结果。
在总共 985 例 TAVI 手术中，共发现 37 例血管入路并发症。TAVI 在手术室（70%）或导管室（30%）进行。血管外科会诊在术中（60%）、术后即刻（14%）、TAVI 当天晚些时候（20%）和术后第 1 天（6%）进行。损伤部位包括股总动脉（49%）、股浅动脉（11%）和髂外动脉（41%），有些病例损伤了多条血管。封堵装置位于皮下组织（26%）、前壁（37%）、后壁（11%）、动脉内（11%）、前后壁均封堵（16%）和腹股沟韧带（5%）。损伤包括撕裂（11%）、夹层（38%）和血管破裂（19%）。大多数修复术是直接进行的（64%），采用补片（28%）和旁路（8%）的较少。4 例患者围手术期死亡（11%），2 例死于出血，1 例死于心脏骤停，1 例死于进行性呼吸疾病。
TAVI 手术过程中的血管入路并发症使复杂的患者面临更高的发病率和死亡率风险。仔细的患者选择、正确的入路技术以及在手术室中为高风险患者进行手术并由血管外科医生进行操作，对于最大限度地减少并发症至关重要。
