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首页> 外文期刊>The American Journal of Cardiology >Safety and Efficacy of Using the Viabahn Endoprosthesis for Percutaneous Treatment of Vascular Access Complications After Transfemoral Aortic Valve Implantation
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Safety and Efficacy of Using the Viabahn Endoprosthesis for Percutaneous Treatment of Vascular Access Complications After Transfemoral Aortic Valve Implantation

机译：经股动脉主动脉瓣植入后使用Viabahn内支架术经皮治疗血管通路并发症的安全性和有效性

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摘要

Vascular access complications (VACs) remain one of the biggest challenges when performing transcatheter aortic valve implantation (TAVI). This study aimed to investigate the short- and medium-term safety and efficacy of the Viabahn endoprosthesis (Gore, Flagstaff, AZ) when used to treat TAVI-induced vascular injury. Over a 40-month period, 354 patients underwent true percutaneous transfemoral (TF)-TAVI using a CoreValve and Prostar-XL closure system; this was our study population. A VAC leading to acute intervention occurred in 72 patients (20.3%) - of these, 18 were managed by balloon angioplasty, 48 were treated by Viabahn stenting (technical success rate 98%), and 6 needed surgical intervention. Overall, this approach resulted in a major VAC rate of 3.1% (n = 11) in our study cohort. Length of hospitalization and 30-day mortality rates were comparable in patients with a VAC treated by Viabahn stenting versus patients without vascular complications. Two patients (4.5%) presented with new-onset claudication; one of them had the stent implanted covering the deep femoral artery (DFA). At medium-term follow-up (median 372 days; range 55 to 978 days) duplex ultrasound showed 100% patency of the Viabahn endoprostheses with no signs of stent fracture or in-stent stenosis/occlusion. In conclusion, the use of self-expanding covered stents is safe and effective in case of TF-TAVI-induced vascular injury, with good short- and medium-term outcomes. Importantly, coverage of the DFA should be avoided. If confirmed by long-term (>5 years) follow-up studies, this strategy for treating TAVI-induced VAC may be used routinely in high-risk patients. (C) 2015 Elsevier Inc. All rights reserved.
机译：在进行经导管主动脉瓣植入术（TAVI）时，血管通路并发症（VACs）仍然是最大的挑战之一。这项研究旨在研究Viabahn内置假体（Gore，Flagstaff，AZ）在治疗TAVI引起的血管损伤时的短期和中期安全性和有效性。在40个月的时间内，使用CoreValve和Prostar-XL闭合系统对354例患者进行了真正的经皮经股（TF）-TAVI治疗;这是我们的研究人群。导致急性干预的VAC发生在72例患者中（20.3％）-其中18例通过球囊血管成形术治疗，48例通过Viabahn支架置入术（技术成功率98％），另外6例需要手术干预。总体而言，在我们的研究队列中，这种方法导致主要VAC率为3.1％（n = 11）。通过Viabahn支架置入VAC的患者与无血管并发症的患者的住院时间和30天死亡率相当。 2例（4.5％）表现为lau行新发;行;其中之一植入了覆盖股骨深部动脉（DFA）的支架。在中期随访时（中位372天;范围为55至978天），双工超声显示Viabahn内置假体100％通畅，没有支架断裂或支架内狭窄/闭塞的迹象。总之，在TF-TAVI引起的血管损伤的情况下，使用自扩张式带覆膜支架是安全有效的，具有良好的短期和中期效果。重要的是，应避免涵盖DFA。如果经过长期（> 5年）的随访研究证实，这种治疗TAVI诱导的VAC的策略可常规用于高危患者。 （C）2015 Elsevier Inc.保留所有权利。

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