Author + information
- Eulogio J. Garcia1,
- Leire Unzue2,
- Rodrigo Teijeiro3,
- Patricia Martin4,
- Carlos Almería4,
- Eduardo García-Jimenez3 and
- Rosana Hernandez-Antolin4
Access site difficulties are a major cause of complications following TAVI procedures. Different techniques have been proposed to optimize the femoral hemostasis, advancing an angioplasty wire from the ipsilateral or contralateral femoral artery in cases of vascular complications. However, once the complication is in place, it may be difficult to cross the bleeding point with a wire. This study sought to evaluate the usefulness of a systematic "Crossover wire Technique" advanced from the contralateral femoral artery at the beginning of the procedure, to manage potential vascular complications and to improve the hemostasis during TAVI procedures.
Retrospective analysis of 159 patients undergoing TAVI with 18F introducer and percutaneous closure with Prostar device were analyzed. Patients were divided into 2 sequential groups: group I ("without wire", n=57, treated up to July 2010) and group II (n=112), including patients since August 2010 that underwent the "Crossover wire technique". Pre-procedural variables, complications (VARC-2 criteria) and treatment were compared.
Results are expressed in the table. Total number of vascular complications was similar in both groups. Prostar closure failure resulted the most frequent complication. Life threatening bleedings (3 vs 12%, p=0.04), major vascular complications (7 vs 18%, p=0.04) and mortality (6 vs 18%) were lower in group II. Surgical repair was undertaken more frequently in group I (7 vs 1%, p=0.06) while a percutaneous management with covered stent implantation was preferred in group II (21 vs 9%, p=0.05).
The "Crossover wire technique" does not reduce the incidence of vascular complications but decreases their severity and clinical impact, facilitating a percutaneous resolution. The team experience might have influenced in the results.
|Group 1(57)||Group 2(112)||p|
|30-day complications in both groups (VARC-2 definitions) and mortality|
|Bleedings||17 (30)||21 (19)||0.19|
|Life threatening bleedings||7 (12)||3 (3)||0.04 (*)|
|Major bleedings||1 (2)||6 (5)||0.42|
|Minor bleedings||9 (16)||12 (11)||0.47|
|Total vascular complications||23 (40)||31 (28)||0.54|
|Major vascular complication||10 (18)||7 (6)||0.04 (*)|
|Minor vascular complication||9 (16)||20 (18)||0.65|
|Closure device failure||4 (7)||5 (4)||0.72|
|Balloon angioplasty for complication management||8 (14)||8 (7)||0.21|
|Stent implantation for complication management||5 (9)||22 (20)||0.05 (*)|
|Surgical repair||4 (7)||1 (1)||0.06|
|Global mortality||10 (18)||6 (5.4)||0.02 (*)|
|Vascular complication mortality||3 (5)||0 (0)||0.05 (*)|