Iatrogenic Lesion of the Common Femoral Artery

Vascular complications are frequent adverse events associated with Transfemoral Transcatheter Aortic Valve Implants (TF-TAVI). An 86 year-old woman with severe aortic valve stenosis admitted in Cardiology for an elective TAVI. Through a bifemoral percutaneous access, an aortic valve was correctly implanted. After unsuccessful percutaneous closure of the common femoral artery, a stent-graft was deployed through a cross-over femoral access to contain bleeding. A new angiography showed active bleeding and absence of femoral outflow. The patient underwent emergent surgery, where the stent was confirmed partially deployed outside the artery. The device was removed and patch angioplasty was performed. Percutaneous access is considered a less invasive approach. Nevertheless, it associates up to 46.3% complications and up to 24.4% of the sere quire surgery [1]. So is this really less invasive or is it the cost of interventional cardiology? The use of covered stent in the common femoral artery can be lifesaving. However, it may cause severe limb ischemia and may jeopardize vascular access for future procedures. In our experience, open repair is preferred over stenting of the common femoral artery, which should be safed for life-threatening haemorrheges. Open and percutaneous access should both be considered to provide a tailor-made approach.