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Incidence and Risk Factor of Vascular Complication in Transcatheter Aortic Valve Replacement via a Transfemoral Approach
Takayuki Kawashima, Sr.1, Akihiro Yoshitake1, Kazuma Okamoto1, Shiji Kawaguchi1, Akinori Hirano1, Mio Kasai1, Yuta Akamatsu1, Hidetoshi Oka1, Kentaro Hayashida1, Shinji Miyamoto2, Keiichi Fukuda1, Hideyuki Shimizu1.
1Keio University Hospital, Tokyo, Japan, 2Oita University Hospital, Oita, Japan.

In transcatheter aortic valve replacement (TAVR) via a transfemoral approach, vascular complications have been associated with increased morbidity and mortality. This study sought to evaluate the incidence and risk factors of vascular complications in TAVR.
We performed a retrospective review of 120 patients received transfemoral TAVR between October 2013 and July 2015 at our institution. The predictor for vascular complication, including risk factors for arteriosclerosis (age, smoking history, diabetes, dyslipidemia), ankle-brachial index, the minimal iliofemoral artery luminal diameter (MLD) , sheath and valve size and procedure (puncture or cut down) were analyzed.
Vascular complications occurred in sixteen of 120 (13%) patients. Vascular complication included type A aortic dissection in 2 patients, iliofemoral artery dissection or perforation in 11 patients and bleeding of the puncture site in 3 patients. On univariate analysis, there was no predictor associated with all vascular complication, whereas the only MLD was associated with iliofemoral artery dissection or perforation (p= 0.022) . By receiver operating characteristic (ROC) analysis, a MLD cutoff value of 6.05 mm had 76.1% sensitivity and 81.8 specificity in iliofemoral artery dissection or perforation (area under curve 0.77) . MLD of ≤ 6.0 mm was thought to be strong predictor for iliofemoral artery injury (Odds ratio 14.37; 95% confidence interval: 3.34- 61.87, p< 0.0001) on univariate analysis.
The incidence of vascular complication was 13% in tranfemoral TAVR. In small iliofemoral case, particularly MLD of ≤ 6.0 mm, transfemoral approach should be avoided.

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