Background
Transfemoral transcatheter aortic valve replacement (TAVR) procedures require secondary
vascular access for inserting accessory catheters and performing percutaneous repair
of femoral artery injury. Use of the transbrachial approach for secondary vascular
access in TAVR procedures has not been reported.
Methods
This study identified 48 patients at the current institution who had undergone transfemoral
TAVR utilising transbrachial secondary vascular access. Efficacy and safety of this
strategy for achieving a successful totally percutaneous procedure were examined.
Study endpoints were occurrence of vascular complications and bleeding related to
transbrachial access, as well as periprocedural and 1-year mortality.
Results
Mean patient age was 80±7 years and Society of Thoracic Surgeons Predicted Risk of
Mortality score was 10.6±3.1. Sizes of sheaths inserted into the brachial artery were
6 Fr (85%), 8 Fr (2%), and 9 Fr (13%). Transbrachial access was used for delivering
stent grafts to the femoral artery in 13% of the patients, inflation of an occlusive
balloon within the iliac artery in 10%, and treatment of iatrogenic femoral artery
stenosis in 2%. Successful valve replacement was achieved in all cases. Brachial sheaths
were removed by manual compression following administration of protamine sulfate.
There were no major access site complications or VARC-3 type ≥2 bleeding related to
the brachial vascular access. Brachial artery occlusion occurred in two patients (4%)
who underwent surgical vascular repair. Two (2) additional patients developed mild
arm ischaemia, which was treated conservatively. Periprocedural mortality was 0% and
early mortality was 8%.
Conclusions
Transbrachial secondary access in TAVR procedures was feasible and enabled percutaneous
vascular repair in cases of femoral artery injury.
Keywords
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Article info
Publication history
Published online: March 08, 2022
Accepted:
January 27,
2022
Received in revised form:
November 30,
2021
Received:
September 18,
2021
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
