Meertens Max, Wegner Moritz, Fischnaler Carlos, Wienemann Hendrik, Macherey Sascha, Lee Samuel, Kuhn Elmar, Mauri Victor, Dorweiler Bernhard, Baldus Stephan, Adam Matti, Ahmad Wael
Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany.
J Endovasc Ther. 2025 Aug;32(4):1146-1154. doi: 10.1177/15266028231204291. Epub 2023 Oct 18.
Access-related vascular complications in transfemoral transcatheter aortic valve implantation (TAVI) can be treated endovascularly or surgically. The aim of this study was to evaluate the short- and long-term outcomes of endovascular treatment compared with surgical repair for access-related vascular complications.
This retrospective study was performed from January 1, 2018, to December 31, 2020. All transfemorally treated TAVI patients in whom a surgical or endovascular treatment for an access site complication was needed were included. The primary outcome was the need for any related vascular re-operation.
In total, 1219 transfemoral TAVI procedures were conducted during the study period. 19 patients suffered an access complication requiring endovascular treatment, while 54 patients required surgical repair. No differences were seen with regard to re-operations (endovascular 15.8% vs surgical 14.8%; p=0.919), wound infections (endovascular 0% vs surgical. 11.1%; p=0.129), and wound healing disorders (endovascular 15.8% vs surgical 29.6%; p=0.237). Patients undergoing endovascular treatment were discharged earlier (endovascular 11.2 vs surgical 14.9 days; p=0.028). After surgical repair, patients received significantly more blood transfusions than endovascularly treated patients (endovascular 1.00 vs surgical 3.1 red blood cell concentrate bags; p<0.001). No differences were found regarding the new onset of walking pain, rest pain, and ischemic ulcers during follow-up.
In this retrospective cohort, endovascular treatment of access-related vascular complications of transfemoral TAVI procedures was safe and feasible. During the hospital stay, endovascularly treated patients received fewer blood transfusions and were discharged faster than surgically treated patients. No differences regarding clinical outcomes and re-intervention rates were seen during the follow-up.Clinical ImpactGiven the in this retrospective study demonstrated safety and feasibility of endovascular treatment for major access-related vascular complications, along with the in-hospital benefits and absence of follow-up disadvantages compared to surgical treatment, endovascular treatment should be considered in cases of major access-related vascular complications in transfemoral TAVI patients.
经股动脉经导管主动脉瓣植入术（TAVI）中与入路相关的血管并发症可通过血管腔内治疗或手术治疗。本研究的目的是评估与手术修复相比，血管腔内治疗入路相关血管并发症的短期和长期疗效。
本回顾性研究于2018年1月1日至2020年12月31日进行。纳入所有需要对入路部位并发症进行手术或血管腔内治疗的经股动脉治疗的TAVI患者。主要结局是是否需要进行任何相关的血管再次手术。
在研究期间共进行了1219例经股动脉TAVI手术。19例患者发生入路并发症需要血管腔内治疗，54例患者需要手术修复。在再次手术方面（血管腔内治疗15.8% vs 手术治疗14.8%；p=0.919）、伤口感染方面（血管腔内治疗0% vs 手术治疗11.1%；p=0.129）以及伤口愈合障碍方面（血管腔内治疗15.8% vs 手术治疗29.6%；p=0.237）均未发现差异。接受血管腔内治疗的患者出院更早（血管腔内治疗11.2天 vs 手术治疗14.9天；p=0.028）。手术修复后，患者接受的输血显著多于血管腔内治疗的患者（血管腔内治疗1.00袋 vs 手术治疗3.1袋红细胞浓缩液；p<0.001）。在随访期间，行走疼痛、静息痛和缺血性溃疡的新发情况未发现差异。
在这个回顾性队列中，经股动脉TAVI手术入路相关血管并发症的血管腔内治疗是安全可行的。在住院期间，血管腔内治疗的患者输血较少，出院比手术治疗的患者更快。在随访期间，临床结局和再次干预率方面未发现差异。临床影响鉴于本回顾性研究证明了血管腔内治疗主要入路相关血管并发症的安全性和可行性，以及与手术治疗相比在住院期间的益处和随访期间无劣势，对于经股动脉TAVI患者的主要入路相关血管并发症，应考虑血管腔内治疗。
