Routine Ultrasound or Fluoroscopy Use and Risk of Vascular/Bleeding Complications After Transfemoral TAVR.
OBJECTIVES
This study aimed to examine the benefits of routine use of 2D-US in patients undergoing transfemoral transcatheter aortic valve replacement (TAVR).


BACKGROUND
Two-dimensional ultrasound (2D-US) reduces access-related vascular complications (VCs) and bleeding in patients undergoing percutaneous coronary intervention via transfemoral approach. Potential similar benefits in patients undergoing transfemoral TAVR have not been systemically investigated.


METHODS
Rates of access-related VCs or bleeding were compared using 5-year retrospective observational data from 2 neighboring high-volume UK TAVR centers systemically using 2 different techniques (center 1: fluoroscopy and contralateral angiography [FCA], center 2: 2D-US) for femoral puncture at the time of transfemoral TAVR.


RESULTS
Overall, 1,171 patients were included in the study (FCA, n = 624; 2D-US, n = 529). Baseline clinical and procedural characteristics were similar between the 2 groups. There was no difference in the risk of VCs, bleeding, or their composite according to femoral puncture technique (FCA vs. 2D-US: 6.7% [95% confidence interval (CI): 4.9% to 8.9%] vs. 6.8% [95% CI: 4.8% to 9.3%]; p = 0.63; 6.1% [95% CI: 4.4% to 8.2%] vs. 6.4% [95% CI: 4.8% to 9.3%]; p = 0.70; and 9.8% [95% CI: 7.6% to 12.4%] vs. 9.8% [95% CI: 7.4% to 12.7%]; p = 0.76, respectively) and no difference when analysis was restricted to a composite of major VCs or major and life-threatening bleeding.


CONCLUSIONS
Vascular and bleeding complications can be achieved using either FCA or 2D-US guidance. Further studies are required to identify and assess alternative strategies to reduce periprocedural VCs and bleeding in this patient population.
['Witberg|Guy|G|', 'Tzalamouras|Vasileios|V|', 'Adams|Heath|H|', 'Patterson|Tiffany|T|', 'Roberts-Thomson|Ross|R|', 'Byrne|Jonathan|J|', 'Dworakowski|Rafal|R|', 'MacCarthy|Philip|P|', 'Redwood|Simon|S|', 'Prendergast|Bernard|B|']
D000368:Aged D000369:Aged, 80 and over D002406:Catheterization, Peripheral D005260:Female D005263:Femoral Artery D005471:Fluoroscopy D006801:Humans D008131:London D008297:Male D019106:Postoperative Hemorrhage D011677:Punctures D015641:Radiography, Interventional D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D013997:Time Factors D065467:Transcatheter Aortic Valve Replacement D016896:Treatment Outcome D018084:Ultrasonography, Interventional D014652:Vascular Diseases
bleeding TAVR vascular complications 2-dimensional ultrasound arterial access