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The Iliofemoral tortuosity score predicts access and bleeding complications during transfemoral transcatheter aortic valve replacement: Data from the VIenna Cardio Thoracic aOrtic valve registrY (VICTORY)
Author(s) -
Mach Markus,
Poschner Thomas,
Hasan Waseem,
Szalkiewicz Philipp,
Andreas Martin,
Winkler Bernhard,
Geisler Stephanie,
Geisler Daniela,
Rudziński Piotr N.,
Watzal Victoria,
Strouhal Andreas,
Adlbrecht Christopher,
DelleKarth Georg,
Grabenwöger Martin
Publication year - 2021
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.13491
Subject(s) - medicine , valve replacement , clinical endpoint , tortuosity , cardiology , framingham risk score , incidence (geometry) , surgery , radiology , randomized controlled trial , stenosis , physics , geotechnical engineering , disease , optics , porosity , engineering
Background Arterial 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. Methods The 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. Results Among 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). Conclusion Vascular 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.