Computed tomography measurement of the femoral artery depth at the puncture site to predict vascular complications after transfemoral transcatheter aortic-valve implantation

Background Vascular complications remain an important issue after transfemoral (TF) transcatheter aortic-valve implantation (TAVI) although their incidence has decreased with improved patient selection using computed tomography and size reduction of introducers. We aimed to evaluate the impact of the femoral artery depth on vascular complications after TAVI. Methods We performed a retrospective study of 679 consecutive TF TAVI patients. Vascular complications were defined by the Valve Academic Rresearch Consortium (VARC)-2. Using CT, we measured the sheath/femoral artery ratio (SFAR) and femoral artery depth immediately above the bifurcation. Receiver operating characteristic (ROC) curves were used to predict major vascular complications and the need for a femoral stent-graft. Results The mean age and logistic EuroSCORE of the studied population were 83.9 ± 6.0 years and 15.4 ± 8.9%, respectively. A balloon-expandable transcatheter heart valve was used in 85.8%. The median values of SFAR and femoral artery depth were 0.73 (0.63–0.83) and 49.0 (36.2–66.7) mm, respectively. Major vascular complications occurred in 5.4% and a femoral stent-graft was used in 7.2%. SFAR predicted major vascular complications [AUC: 0.64 (95% CI: 0.54–0.75), P = 0.005] but not the need of a femoral stent-graft [AUC: 0.52 (95% CI: 0.43–0.60), P = 0.68]. In contrast, depth of femoral artery predicted the need of a femoral stent-graft [AUC: 0.62 (95% CI: 0.54–0.69), P = 0.007] but not major vascular complications [AUC: 0.55 (95% CI: 0.46–0.65), P = 0.27]. Conclusions The results of our study suggest that SFAR and femoral artery depth measurements using CT provide additional information to predict major vascular complication or the need of a femoral stent-graft after TF TAVI.