Retrograde Femoral Artery Stent-Graft Implantation for Treatment of Access-site Bleeding Following Transcatheter Aortic Valve Implantation

Isr Med Assoc J. 2019 May;21(5):322-325.

Abstract

Background: Access-site bleeding is a common complication of transfemoral transcatheter aortic valve implantation (TAVI). Percutaneous stent-graft implantation within the femoral artery may achieve hemostasis and avert the need for more invasive surgical vascular repair; however, failure to advance a guidewire antegradely via the injured vessel may preclude stent delivery. While retrograde stent-graft delivery from the distal vasculature may potentially enable percutaneous control of bleeding, this approach has not been reported.

Objectives: To assess the feasibility of a retrograde approach for stent-graft implantation in the treatment of access-site bleeding following transfemoral TAVI.

Methods: A prospective TAVI registry was analyzed. Of 349 patients who underwent TAVI, transfemoral access was used in 332 (95%). Access-site injury requiring stent-graft implantation occurred in 56 (17%). In four patients (7%), antegrade wiring across the site of vascular injury was not possible and a retrograde approach for stent delivery was used.

Results: Distal vascular access was achieved via the superficial femoral or profunda artery. Retrograde advancement of a polymer-coated 0.035" wire to the abdominal aorta, followed by stent-graft delivery to the common femoral artery, achieved hemostasis in all cases. During a median (interquartile range) follow-up period of 198 (618) days (range 46-2455) there were no deaths and no patient required additional vascular interventions.

Conclusions: A retrograde approach for stent-graft delivery is feasible and allows percutaneous treatment of a common femoral artery injury following TAVI in patients who are not suitable for the conventional antegrade approach.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve / surgery*
  • Aortic Valve Stenosis / surgery*
  • Catheterization, Peripheral* / adverse effects
  • Catheterization, Peripheral* / methods
  • Feasibility Studies
  • Female
  • Femoral Artery / surgery*
  • Heart Valve Prosthesis
  • Hemostasis, Surgical / methods
  • Humans
  • Intraoperative Complications* / etiology
  • Intraoperative Complications* / therapy
  • Male
  • Outcome and Process Assessment, Health Care
  • Postoperative Hemorrhage* / etiology
  • Postoperative Hemorrhage* / therapy
  • Transcatheter Aortic Valve Replacement* / adverse effects
  • Transcatheter Aortic Valve Replacement* / instrumentation
  • Transcatheter Aortic Valve Replacement* / methods
  • Vascular System Injuries* / etiology
  • Vascular System Injuries* / therapy