Study Of Femoral Access For Transcatheter Aortic Valve Replacement In Patients With Aortic Regurgitation

Objective:To investigate the variation of femoral artery access diameter during the cardiac cycle in patients with aortic regurgitation(AR)and to provide a basis for peripheral access for transcatheter aortic valve replacement(TAVR).Methods:Thirty-four patients who were proposed to undergo TAVR with complete cardiac gated iliofemoral artery scan from June 2022 to February 2023 were prospectively included in Fuwai Hospital of Yunnan Province.All patients underwent transthoracic echocardiography(TTE)before surgery,including 23 patients with moderate to severe AR and 11 patients with moderate to severe aortic stenosis(AS).The patients were divided into two groups,the study group(AR)and the control group(AS),and the differences between the clinical data,preoperative echocardiographic data,and preoperative iliofemoral CT measurements were compared between the two groups.The changes in the lumen-related parameters of the common iliac artery,external iliac artery,and femoral artery measured during systole and diastole were compared with the cardiac cycle in the two groups,respectively.Results:1.34 patients in this study were 18 males and 16 females,with a mean age of 72.0±6.3 years,including the AR group:52.2%males and 47.8%females,with a mean age of 71.2±5.8 years;the AS group:54.5%males and 45.5%females,with a mean age of 73.6±7.56 years.The AR group with hypertension was significantly higher than the AS group.The left ventricular end diastolic diameter(LVEDD)was greater in the AR group compared with the AS group(59.8±7.8 mm vs.50.8±7.9 mm,P=0.004).2.Comparing the iliofemoral artery cardiac gated CT scan with the volumetric scan mode,in the objective evaluation indexes CT values at the opening of the common iliac artery(440.3±160.8HU vs.477.4±118.3HU,P=0.283),CT values at the opening of the external iliac artery(412.2±153.9HU vs.448.8±123.5 HU,P=0.284),femoral CT values at the arterial opening(400.5±145.0HU vs.425.6±129.4HU,P=0.454)were not statistically different;in the subjective score there was no statistical difference in CT image quality between the two groups(4.41±0.66 vs.4.76±0.43,P=0.057).3.Measurements of the common iliac artery,external iliac artery,and common femoral artery(anterior-posterior diameter,right and left diameter,area,and circumference)were in good agreement during the systolic and diastolic phases of the prospective cardiac gated scan compared with the volumetric scan modality,respectively.In the AR group,the anterior-posterior diameter of the left common iliac artery(1.14±0.22cm vs.1.09±0.21cm,P<0.001),the right and left diameter of the common iliac artery(1.11±0.22cm vs.1.05±0.20cm,P=0.02),common iliac artery area(1.06±0.40cm~2 vs.0.97±0.35cm~2,P<0.001),and common iliac artery circumference(3.65±0.68cm vs.3.50±0.63cm,P<0.001);left external iliac artery anterior-posterior diameter(0.82±0.17cm vs.0.77±0.17cm,P<0.001),left and right external iliac artery diameters(0.82±0.15cm vs.0.76±0.15cm,P<0.001),external iliac artery area(0.56±0.22cm~2 vs.0.49±0.19cm~2,P<0.001),and external iliac artery circumference(2.70±0.53cm vs.2.53±0.52cm,P<0.001);anterior and posterior diameters of the left common femoral artery(0.83±0.13cm vs.0.78±0.12cm,P<0.001),left and right diameters of the common femoral artery(0.82±0.13cm vs.0.77±0.13cm,P<0.001),and area of the common femoral artery(0.57±0.18cm~2 vs.0.49±0.17cm~2,P<0.001),common femoral artery circumference(2.71±0.43cm vs.2.54±0.42cm,P<0.001);right common iliac artery anterior-posterior diameter(1.14±0.19cm vs.1.06±0.19cm,P<0.001),common iliac artery right and left diameter(1.12±0.18cm vs.1.05±0.18cm,P<0.001),common iliac artery area(1.03±0.31cm~2 vs.0.91±0.30cm~2,P<0.001),and common iliac artery circumference(3.60±0.56cm vs.3.44±0.55cm,P<0.001);right external iliac artery anterior-posterior diameter(0.83±0.15cm vs.0.76±0.13cm,P<0.001),right and left external iliac artery diameters(0.81±0.16cm vs.0.75±0.15cm,P<0.001),external iliac artery area(0.55±0.21cm~2 vs.0.49±0.19cm~2,P<0.001),external iliac artery circumference(2.65±0.50cm vs.2.49±0.47cm,P<0.001);right common femoral artery anterior-posterior diameter(0.82±0.16cm vs.0.77±0.15cm,P<0.001),common femoral artery right and left diameter(0.81±0.15cm vs.0.76±0.14cm,P<0.001),and area of the common femoral artery(0.57±0.20cm~2 vs.0.50±0.17cm~2,P<0.001),common femoral artery circumference(2.67±0.50cm vs.2.54±0.46cm,P<0.001),all of the above measured parameters were greater in the cardiac gated systolic phase than in the diastolic phase,and the differences were statistically significant.In the AS group,the systolic phase was greater than the diastolic phase for the left common iliac artery left and right,common iliac artery area,common iliac artery circumference,common femoral artery anterior and posterior diameter,common femoral artery left and right diameter,common femoral artery circumference,common femoral artery anterior and posterior diameter,common femoral artery left and right diameter,common femoral artery area,and common femoral artery circumference,all of which were statistically different(P<0.05).There was no statistically significant difference in the rest of the measured parameters in the AS group in the two-phase comparison.Conclusion:In patients with moderate to severe AR or AS combined with moderate to severe AR,ECG gated serial scans show that the femoral artery access lumen changes with cardiac cycle motion,and the internal diameter of the iliofemoral artery during systole is larger than the diastolic internal diameter,suggesting that the femoral artery access lumen is dilated during systole.It is more accurate to select the type of interventional sheath according to the systolic internal diameter of the iliofemoral artery.