P219 - SAFETY AND EFFICACY OF COVERED STENTS FOR MANAGING VASCULAR ACCESS COMPLICATIONS AFTER TRANSFEMORAL TRANSCATHETER AORTIC VALVE REPLACEMENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background: Vascular access complications (VACs) after transfemoral transcatheter aortic valve replacements (TAVR) range from 10-20%. Percutaneous management of VACs such with covered stenting is minimally invasive and appealing in this high-risk population. However, their long-term efficacy and safety remain unclear. The objective of this study is to evaluate the safety and efficacy of covered stents in managing VACs post transfemoral TAVR.

METHODS AND RESULTS: We performed a systematic review and meta-analysis of observational studies per PRISMA 2020 guidelines. Eligible studies included patients who had undergone transfemoral TAVR and subsequently developed a VAC managed with covered stenting. Data extraction was performed independently by two reviewers.

A comprehensive literature search identified 39 articles of which 13 met inclusion criteria. 6729 patients underwent transfemoral TAVR with 746 (11.1%) VACs, 521 (69.8%) of which were treated percutaneously. All patients were intermediate to high risk. Short-term stent-related complications were 1.9%, with an overall technical success rate of 96%. Coverage of the profunda femoris artery contributed to 47.62% of technical failures, 60% of which were symptomatic. Long-term follow-up was available in 11 studies with a median duration of 24.2 months. Long-term complication rates were 4.4%. Stent fractures were rare (4 cases). Primary patency rates were high across studies; however, heterogeneity in reporting was high. The 30-day mortality rate was 2.4%, with deaths attributed to comorbidities, procedural complications, or the severity of the initial VAC, and no stent-related mortalities.

Conclusion: Covered stents appear to be a safe and effective intervention in the intermediate to high-risk TAVR population. Complications may be underreported due to limited long-term surveillance and publication biases.