Computed tomography derived anatomical predictors of vascular access complications following transfemoral transcatheter aortic valve implantation: A systematic review

Background: Vascular complications after percutaneous transfemoral transcatheter aortic valve implantation (TAVI) are associated with adverse clinical outcomes and remain a significant challenge.Aims: The purpose of this review is to synthesize the existing evidence regarding the iliofemoral artery features predictive of vascular complications after TAVI on pre -procedural contrast -enhanced multidetector computed tomography (MDCT).Methods: A systematic search was performed in Embase and Medline (Pubmed) databases. Studies of patients undergoing transfemoral TAVI with MDCT were included. Studies with only valve -in -valve TAVI, planned surgical intervention and those using fluoroscopic assessment were excluded. Data on study cohort, procedural characteristics and significant predictors of vascular complications were extracted.Results: We identified 23 original studies involving 8697 patients who underwent TAVI between 2006 and 2020. Of all patients, 8514 (97.9%) underwent percutaneous transfemoral-TAVI, of which 8068 (94.8%) had contrast -enhanced MDCT. The incidence of major vascular complications was 6.7 +/- 4.1% and minor vascular complications 26.1 +/- 7.8%. Significant independent predictors of major and minor complications related to vessel dimensions were common femoral artery depth (>54 mm), sheath-to-iliofemoral artery diameter ratio (>0.91-1.19), sheath -to -femoral artery diameter ratio (>1.03-1.45) and sheath -to -femoral artery area ratio (>1.35). Substantial iliofemoral vessel tortuosity predicted 2-5 -fold higher vascular risk. Significant iliofemoral calcification predicted 2-5 -fold higher risk. The iliac morphology score was the only hybrid scoring system with predictive value.Conclusions: Independent iliofemoral predictors of access-site complications in TAVI were related to vessel size, depth, calcification and tortuosity. These should be considered when planning transfemoral TAVI and in the design of future risk prediction models.