SPC365

Viabahn stents for treating TAVI-related vascular access complications – a single-centre experience

Session: Sessão de Posters 26 - TAVI: acessos vasculares
Speaker: André Paulo Ferreira

Congress: CPC 2024
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Cartazes
FP Number: ---
Authors: André Paulo Ferreira; Rita Teixeira; André Grazina; Inês Rodrigues; Alexandra Castelo; Tiago Mendonça; Luís Morais; Rúben Ramos; António Fiarresga; Rui Cruz Ferreira; Duarte Cacela

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Background: </span></span></strong><span style="font-size:11.0pt"><span style="color:black">Vascular access complications (VACs) remain one of the biggest challenges when performing transcatheter aortic valve implantation (TAVI). Historically, concerns regarding stent placement in flexing points have been a deterrent to the percutaneous treatment of VACs, due to the potential development of claudication over time. The Viabahn stent, being a covered stent that offers flexibility and conformability, may be well-suited for deployment in these anatomies.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Purpose: </span></span></strong><span style="font-size:11.0pt"><span style="color:black">This study aimed to evaluate the safety and efficacy of the iliofemoral Viabahn stenting for treating TAVI-related VACs.</span></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">&nbsp; &nbsp;&nbsp;</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Methods: </span></span></strong><span style="font-size:11.0pt"><span style="color:black">Retrospective analysis of patients submitted to Viabahn stenting</span></span> <span style="font-size:11.0pt"><span style="color:black">in the iliofemoral sector for TAVI-related VACs in a single tertiary centre between January 2017 and October 2023. Baseline characteristics, procedure data and complications were noted according to the Valve Academic Research Consortium-2.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Results:</span></span></strong><strong> </strong><span style="font-size:11.0pt"><span style="color:black">A total of 722 patients were submitted to transfemoral TAVI during the study period. Of these, 25 (3.6%) underwent Viabahn stenting to treat TAVI-related VACs and were included in this study. Patient mean age was 82.1&plusmn;6.13 years, 61.2% were male. At the baseline, patients had a mean Euroscore II of 2.73&plusmn;1.91. A unilateral access approach was used in 40% of cases. The median size of the main access sheath was 14 Fr [IQ 14-16], and the closure devices deployed were Manta&reg; in 72%, and Perclose&reg; in 28%. The Viabahn stent treated different types of VACS, including vessel rupture in 56%, acute dissection in 28% (12% with no antegrade flow), and failed sealing in 16%. The complicated artery was the common femoral in 82%, and the external iliac in 18%. Percutaneous treatment with Viabahn stenting was successful in 92% of cases. In two cases (8%), one of acute occlusion and one of vessel rupture, vascular surgery was required. During the hospital stay, there were no further vascular or hemorrhagic complications. After a mean follow-up of 15 months, 20% of patients were evaluated by Doppler which showed no signs of restenosis or stent complications. Only one patient experienced lower limb claudication at 1 year due to stent restenosis detected in the CT scan, which was managed with medical therapy. There were no other adverse vascular events during follow-up. </span></span></span></span></p>

<p style="text-align:justify"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Conclusion: </span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Our study suggests that<strong> </strong>Viabahn stenting emerges as a valuable therapeutic option, ensuring long-term safety and efficacy, in the complex realm of TAVI-related vascular complications.</span></span></span></p>