• Eur. J. Clin. Invest. · Jun 2021

    Iliofemoral tortuosity score predicts access and bleeding complications during transfemoral transcatheter aortic valve replacement.

    • Markus Mach, Thomas Poschner, Waseem Hasan, Philipp Szalkiewicz, Martin Andreas, Bernhard Winkler, Stephanie Geisler, Daniela Geisler, Piotr N Rudziński, Victoria Watzal, Andreas Strouhal, Christopher Adlbrecht, Georg Delle-Karth, and Martin Grabenwöger.
    • Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
    • Eur. J. Clin. Invest. 2021 Jun 1; 51 (6): e13491.

    BackgroundArterial tortuosity is linked to a higher risk of adverse clinical events after transfemoral transcatheter aortic valve replacement (TF-TAVR). Currently, there are no assessment tools that can quantify this variable in three-dimensional space. This study investigated the impact of novel scoring methods of iliofemoral tortuosity on access and bleeding complications after TF-TAVR.MethodsThe main access vessel was assessed between the aortoiliacal and femoral bifurcation in preoperative multislice computed tomography scans of 240 consecutive patients undergoing TF-TAVR. Tortuosity was assessed by three methods: largest single angle, sum of all angles, and iliofemoral tortuosity (IFT) score [((true vessel length/ideal vessel length)-1)*100]. The primary study endpoint was a composite of access and bleeding complications. The secondary study endpoints were 30-day mortality and long-term survival.ResultsAmong 240 patients, only the IFT score demonstrated a good positive correlation with the composite primary endpoint of access and bleeding complications (P = 0.031). A higher incidence of access and bleeding complications was found in patients with a higher IFT score (56 [36.8%] vs 17 [19.3%]; P = 0.003). In a multivariate logistic regression analysis, only the IFT score was a significant predictor of the primary endpoint (OR: 2.11; 95% CI: 1.09-4.05; P = 0.026).ConclusionVascular tortuosity is an underestimated risk factor during TF-TAVR. The IFT score is a valuable tool in risk stratification before TF-TAVR, predicting periprocedural access and bleeding complications.© 2021 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation.

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