Ideally, we will not puncture the femoral artery blindly if we are planning to use a big caliber releasing device and a percutaneous closure device during TAVR. The risk of a high or low puncture or the presence of a lateral branch compromising the puncture site might become a major vascular and bleeding complication.
There is no randomized study on this issue (and there might never be one). This study, published in Circulation Cardiovascular Interventions gathered data from small series and condensed it in this meta-analysis.
Even though significantly lower in number thanks to reduced device diameter and increasing operator expertise with closure devices, vascular and bleeding complications are still a matter of concern for TAVR patients.
This meta-analysis included 8 observational studies with a total 3,875 patients mean age 82.8, STS 5.81 and nearly 25% had peripheral artery disease.
Ultrasound guided femoral access significantly reduced total bleeding risk (OR, 0.50 CI 95%, 0.35 to 0.73), major bleeding (OR 0.51, CI 95%, 0.35 to 0.74) and minor bleeding significantly (OR, 0.59, CI 95% 0.38 to 0.91). It also reduced access site bleeding.
Read also: Device Evolution Also Impacts on Valve in Valve.
IN the absence of randomized studies, this meta-analysis is the best we have, and it suggests a beneficial potential of ultrasound guided access. It is difficult to show definitively since many operators have greater experience in femoral access and also have contralateral access angiographies, which saves time and money.
CIRCINTERVENTIONS-121-010742Original Title: Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access.
Reference: Rafail A Kotronias et al. Circ Cardiovasc Interv. 2021 Sep 20; CIRCINTERVENTIONS121010742. Online ahead of print doi: 10.1161/CIRCINTERVENTIONS.121.010742.
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