Aims: Postprocedural iliofemoral angiography is frequently performed to detect vascular complications after transfemoral transcatheter aortic valve implantation (TAVI). However, the relative value of routine versus selective imaging remains uncertain. This study aimed to compare both strategies with respect to complication rates and clinical outcomes.
Methods: We retrospectively analyzed 1,147 TAVI patients treated at two sites of our center that employed different postprocedural angiography protocols: one site performed routine iliofemoral angiography (BK), while the other applied a selective strategy based on clinical signs and operator discretion (FR). Outcomes included bleeding complications (access-site bleeding, closure device failure, hemoglobin drop, bleeding-related death), vascular complications (dissection, perforation, stenosis, occlusion, or pseudoaneurysm), and vascular reinterventions (surgical repair, catheter-based intervention, or thrombin injection). Associations between angiography strategy and outcomes were assessed using multiple logistic regression models.
Results: Between 2020 and 2024, 473 patients were treated at the FR site with a selective strategy, of whom 153 (32 %) underwent postprocedural iliofemoral angiography. At the BK site, 674 patients treated in 2021 and 2022 underwent routine post-TAVI angiography (98 %).
Overall, 555 patients (48 %) were female; median age was 83.0 (IQR 7.0), median BMI was 25.9 (IQR 5.6)kg/m², median STS score was 3.20 (IQR 3.18), and median left ventricular ejection fraction was 55 (IQR 9) %. Comorbidities included diabetes in 355 (31%), hyperlipidemia in 667 (58 %), hypertension in 956 (83 %), and peripheral arterial disease in 79 (6.9 %). Baseline characteristics were largely similar between the FR and BK cohorts, with the exception of a higher median age (83.2 (IQR 6.4) vs. 82.0 (IQR 7.0)) but a lower median STS score (2.7 (IQR 2.3) vs. 4.3 (IQR 4.1)) in BK.
Bleeding complications occurred in 200 patients (17 %): 147 at BK and 53 at FR (22 % vs. 11 %). Vascular complications were observed in 92 patients (8.0 %): 52 at BK and 40 at FR (7.7 % vs. 8.5 %). Vascular reinterventions were required in 64 patients (5.6 %): 44 at BK and 20 at FR (6.5 % vs. 4.2 %). Logistic regression adjusted for potential confounders revealed significant less bleeding complications for the selective angiography strategy (OR 0.45, 95% CI 0.32–0.63; p < 0.01) accompanied by no impact on vascular complications (OR 1.08, 95% CI 0.66–1.77; p = 0.756), or vascular reinterventions (OR 0.58, 95% CI 0.32–1.07; p = 0.09).
Conclusions: Selective post-TAVI iliofemoral angiography appears to be as safe as a routine strategy, suggesting that routine postprocedural angiography may be omitted in many cases. Randomized controlled trials are warranted to confirm these findings.
