Iliofemoral artery lumen volume assessment with three dimensional multi-detector computed tomography and vascular complication risk in transfemoral transcatheter aortic valve replacement

Yoav Hammer; Uri Landes; Oren Zusman; Ran Kornowski; Guy Witberg; Katia Orvin; Amos Levi; Pablo Codner; Hanna Vaknin-Assa; Mithal Nassar; Gideon Shafir; Abid Assali; Ashraf Hamdan

doi:10.1016/j.jcct.2018.10.009

Iliofemoral artery lumen volume assessment with three dimensional multi-detector computed tomography and vascular complication risk in transfemoral transcatheter aortic valve replacement

J Cardiovasc Comput Tomogr. 2019 Jan-Feb;13(1):68-74. doi: 10.1016/j.jcct.2018.10.009. Epub 2018 Oct 13.

Authors

Affiliations

¹ Cardiology Department, Rabin Medical Center, 39 Jabotinski St., Petah Tikva, 4941492, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv, 69978, Israel.
² Radiology Department, Rabin Medical Center, 39 Jabotinski St., Petah Tikva, Israel.
³ Cardiology Department, Rabin Medical Center, 39 Jabotinski St., Petah Tikva, 4941492, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv, 69978, Israel. Electronic address: hamdashraf@gmail.com.

PMID: 30340961
DOI: 10.1016/j.jcct.2018.10.009

Abstract

Background: Transfemoral Transcatheter Aortic Valve Replacement (TAVR) carries a risk of Vascular Complications (VCs) at the access site. The currently used measures for assessing the risk for VCs are not accurate enough, and sometimes fail to predict them. We therefore aimed to examine whether Iliofemoral artery lumen volume (IFV) assessment with 3-dimensional computed tomography (CT) predicts VCs after transfemoral TAVR.

Methods: We identified 45/560 trans-femoral TAVR patients with VC, then performed nearest neighbor 1:1 matching for patients with no VC, matching for age, sex, TAVR year, valve size and type, closure-device, sheath size and peripheral vascular disease. IFV, minimal diameter, tortuosity, and calcification were measured, and their diagnostic performance assessed.

Results: The final analysis included 45 patients with and 45 patients without VCs. The two groups were well balanced. For all patients, median IFV was 8.65 ml (IQR 6.5-11.95). IFV was lower in patients with VC compared to patients without VC: 7.10 ml (IQR 5.4-9.0) vs. 10.10 ml (IQR 8.3-13.3), p < 0.001. VC risk had marginal association with iliofemoral artery minimal diameter (p = 0.06) and no association with tortuosity or calcification. Compared with other measurements, IFV had the most favorable receiver operating curve for the prediction of VC, with an area under the curve (AUC) of 0.78.

Conclusion: IFV measurement using 3-dimensional CT is significantly associated with VCs in transfemoral TAVR patients and might be superior to currently accepted parameters. IFV should be further studied among extended cohorts of TAVR treated patients as a novel tool for VC risk assessment prior to transfemoral TAVR.

Keywords: Computed tomography; Iliofemoral artery lumen volume; TAVR; Vascular complications.

MeSH terms

Aged, 80 and over
Case-Control Studies
Catheterization, Peripheral / adverse effects*
Catheterization, Peripheral / methods
Computed Tomography Angiography / methods*
Databases, Factual
Female
Femoral Artery / diagnostic imaging*
Humans
Imaging, Three-Dimensional / methods*
Male
Multidetector Computed Tomography / methods*
Peripheral Arterial Disease / complications
Peripheral Arterial Disease / diagnostic imaging*
Predictive Value of Tests
Radiographic Image Interpretation, Computer-Assisted / methods*
Risk Assessment
Risk Factors
Transcatheter Aortic Valve Replacement / adverse effects*
Treatment Outcome
Vascular System Injuries / diagnostic imaging
Vascular System Injuries / etiology*
Vascular System Injuries / therapy