Ronen Jaffe

A 69-year-old diabetic man with morbid obesity underwent elective angioplasty for a chronic total occlusion of the left anterior descending coronary artery via right radial and right femoral access. Clinical Images from Journal of Invasive Cardiology. common femoral artery vascular stents

Background/Objectives: We sought to evaluate changes in hemoglobin level and renal function in patients 5–12 months after transcatheter aortic valve replacement (TAVR), and to examine possible relationships between these changes. Anemia is common in older people with severe aortic stenosis (AS). The two most common etiologies for anemia in this population are iron deficiency due to gastrointestinal blood loss and renal failure. Angiodysplasia in the gastrointestinal system is a feature of AS syndrome. Methods: We collected clinical data, including hemoglobin level and renal function before and 5–12 months after TAVR in 315 consecutive patients. To examine whether calculated clinical predictors such as EuroScore 2 are associated with the persistence of anemia after TAVR, we performed multivariable correlation analysis with post-TAVR anemia as the dependent variable. Results: The mean hemoglobin level increased significantly (from 11.76 to 12.16 g/dL, p < 0.0001) 5–12 months after TAVR, and the number of patients with anemia decreased significantly (from 67.5% to 53.9%, p < 0.0001). At 5–12 months following TAVR, a small reduction in estimated glomerular filtration rate was observed (from 60.05 ± 24.1 to 58.30 ± 24.50 mL/min, p = 0.024). The multivariable correlation analysis did not identify clinical predictors of persistent anemia. Conclusions: A significant increase in hemoglobin was observed 5–12 months after TAVR, despite a reduction in renal function. Our findings imply that gastrointestinal blood loss, which occurs in patients with severe AS, is significantly reduced following TAVR.

Transcatheter aortic valve replacement (TAVR) has transformed the treatment of aortic stenosis and should ideally be performed as a totally percutaneous procedure via the transfemoral (TF) approach. Peripheral vascular disease may impede valve delivery, and vascular access site complications are associated with adverse clinical outcome and increased mortality. We review strategies aimed to facilitate TF valve delivery in patients with hostile vascular anatomy and achieve percutaneous management of vascular complications.

We present 2 cases that demonstrate the potential for vascular complications following trans-subclavian TAVR and the role of percutaneous intervention in managing such situations. from Journal of Invasive Cardiology.

An 82-year-old male with severe symptomatic aortic stenosis underwent elective TAVR complicated by rupture of the proximal iliac artery. This case illustrates the feasibility of percutaneous vascular repair following severe vascular injury during TAVR.

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.