Safety of Selective and Routine Femoral Access Angiography Post-Transcatheter Aortic Valve Implantation
Background Postprocedural iliofemoral angiography is commonly used to detect access-site complications after transfemoral transcatheter aortic valve implantation (TF-TAVI). However, the clinical value of routine angiographic surveillance remains uncertain. Aims To compare vascular and access-site-related complications according to Vascular Academic Research Consortium-3 (VARC-3) criteria associated with routine and selective postprocedural iliofemoral angiography after TF-TAVI. Methods We retrospectively analyzed 1,147 TF-TAVI procedures at 2 sites of a single center with different institutional strategies for postprocedural angiographic assessment. One site routinely performed iliofemoral angiography after TAVI (n = 674), whereas the other applied a selective strategy based on procedural suspicion (n = 473). Results Vascular and access-site complications (VARC-3) were similar between strategies (selective 6.6% vs routine 8.0%; OR: 0.76; 95% CI: 0.48-1.19). Routine angiography detected more access-site bleedings (13.9% vs 5.2%; P < 0.001), without differences in hemoglobin drop, transfusion due to access-site bleeding, or bleeding-related death. Overall vascular reinterventions were comparable (4.2% vs 6.5%; P = 0.095), with more catheter-based interventions in the routine strategy and more surgical/thrombin-based interventions in the selective strategy. In adjusted and inverse probability of treatment weights–weighted analyses, bleeding complications remained lower with the selective strategy, whereas overall VARC-3 complications did not differ. After adjustment using the inverse probability of treatment weights model, the angiography strategy was not associated with acute kidney injury despite higher total contrast in the routine group. Conclusion Routine angiography increases detection of minor vascular abnormalities, while selective angiography guided by clinical suspicion may provide comparable clinical outcomes. Routine postprocedural angiography may be unnecessary in many patients. Prospective randomized studies are needed to determine the optimal surveillance strategy.