Anatomical Predictors of Access‐Related Vascular Complications Following Transfemoral Transcatheter Aortic Valve Replacement

ABSTRACT Background Access‐related vascular complications (VCs) after percutaneous transfemoral transcatheter aortic valve replacement (TAVR) are associated with poor clinical outcomes and remain a significant challenge despite technological advances. The aim of this study was to identify anatomic predictors of access‐related VCs after TAVR on preprocedural contrast‐enhanced multidetector computed tomography (MDCT). Aims The aim of this study was to identify anatomical predictors of access‐related VCs after TAVR on preprocedural contrast‐enhanced MDCT. Methods A total of 348 consecutive patients with symptomatic severe AS who underwent transfemoral TAVR were included retrospectively. The primary endpoint of the study was the composite of minor and major access site complications as defined by the Valve Academic Research Consortium‐3 (VARC‐3) criteria. The study population was divided into two groups according to the VC including VC (+) and VC (−). Results A total of 101 patients (29%) developed VC (8.7% major, 20.3% minor) following TAVR. Regression analysis identified severe CFA calcification ( p = 0.004), CFA depth ( p < 0.001), minimum CFA diameter ( p < 0.001), CFA depth‐to‐diameter ratio ≥ 5.6 ( p < 0.001), and sheath‐to‐femoral artery ratio (SFAR) ( p < 0.001) as significant predictors of VC. ROC curves generated for the occurrence of VC, the AUC for the femoral artery depth‐to‐diameter ratio (0.720) was higher than the AUC for the SFAR and the depth of the femoral artery (0.636, 0.630). Conclusion Complications related to vascular access sites continue to be a significant concern for patients undergoing TF‐TAVR. The CFA depth‐to‐diameter ratio has demonstrated superior predictive performance for VC compared to SFAR as expressed in the literature. Utilizing this criterion may enhance risk stratification for VC in high‐risk patients, potentially reducing associated morbidity and mortality.