• Hussein Sliman, Avinoam Shiran, Dallit Mannheim, Eyal Avraham, Ron Karmeli, Nader Khader, Barak Zafrir, Ronen Rubinshtein, and Ronen Jaffe.
• Department of Cardiology, Carmel Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
• Isr Med Assoc J. 2019 May 1; 21 (5): 322-325.

BackgroundAccess-site bleeding is a common complication of transfemoral transcatheter aortic valve implantation (TAVI). Percutaneous stent-graft implantation within the femoral artery may achieve hemostasis and avert the need for more invasive surgical vascular repair; however, failure to advance a guidewire antegradely via the injured vessel may preclude stent delivery. While retrograde stent-graft delivery from the distal vasculature may potentially enable percutaneous control of bleeding, this approach has not been reported.ObjectivesTo assess the feasibility of a retrograde approach for stent-graft implantation in the treatment of access-site bleeding following transfemoral TAVI.MethodsA prospective TAVI registry was analyzed. Of 349 patients who underwent TAVI, transfemoral access was used in 332 (95%). Access-site injury requiring stent-graft implantation occurred in 56 (17%). In four patients (7%), antegrade wiring across the site of vascular injury was not possible and a retrograde approach for stent delivery was used.ResultsDistal vascular access was achieved via the superficial femoral or profunda artery. Retrograde advancement of a polymer-coated 0.035" wire to the abdominal aorta, followed by stent-graft delivery to the common femoral artery, achieved hemostasis in all cases. During a median (interquartile range) follow-up period of 198 (618) days (range 46-2455) there were no deaths and no patient required additional vascular interventions.ConclusionsA retrograde approach for stent-graft delivery is feasible and allows percutaneous treatment of a common femoral artery injury following TAVI in patients who are not suitable for the conventional antegrade approach.

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