Inferior epigastric artery as a landmark for transfemoral TAVI. Optimizing vascular access?

Manolis Vavuranakis, Konstantinos Kalogeras, Dimitrios Vrachatis, Maria Kariori, Vasilios Voudris, Konstantinos Aznaouridis, Carmen Moldovan, Sophia Vaina, Georgios Lazaros, Konstantina Masoura, Sophia Thomopoulou, Christodoulos Stefanadis
Catheterization and Cardiovascular Interventions 2013, 81 (6): 1061-6

OBJECTIVES: This study sought to investigate whether the site of common femoral artery (CFA) cannulation in regard to the inferior epigastric artery (IEA) is associated with the incidence of vascular complications in patients undergoing transfemoral aortic valve implantation (TAVI).

BACKGROUND: Vascular access complications are a main issue during TAVI and have been associated with significant increase of morbidity and mortality. The need for establishment of reliable predictors for these serious events remains important.

METHODS: A total of 90 patients, who had undergone TAVI, were retrospectively studied. Vascular complications were defined as major and minor according to the Valve Academic Research Consortium (VARC) criteria. Patients were divided into high cannulation site (CS) group and low CS group depending on the common femoral artery puncture site position, in regards to the most inferior border of the IEA.

RESULTS: Vascular complications were significantly more frequent in the high CS group versus the low CS group (32.3% vs. 11.9%, P = 0.039). High cannulation remained an independent predictor of vascular complications after adjustment for known risk factors (OR: 4.827, CI: 1.441-16.168; P = 0.011).

CONCLUSIONS: In patients undergoing transfemoral TAVI, arterial puncture above the most inferior border of the IEA is associated with vascular complications.

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