Vascular Access in Patients With Peripheral Arterial Disease Undergoing TAVR: The Hostile Registry.

Palmerini, Tullio; Saia, Francesco; Kim, Won-Keun; Renker, Matthias; Iadanza, Alessandro; Fineschi, Massimo; Bruno, Antonio Giulio; Ghetti, Gabriele; Vanhaverbeke, Maarten; Søndergaard, Lars; De Backer, Ole; Romagnoli, Enrico; Burzotta, Francesco; Trani, Carlo; Adrichem, Rik; Van Mieghem, Nicolas M; Nardi, Elena; Chietera, Francesco; Orzalkiewicz, Mateusz; Tomii, Daijiro; ... (2023). Vascular Access in Patients With Peripheral Arterial Disease Undergoing TAVR: The Hostile Registry. JACC. Cardiovascular Interventions, 16(4), pp. 396-411. Elsevier 10.1016/j.jcin.2022.12.009

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The optimal access route in patients with severe peripheral artery disease (PAD) undergoing transcatheter aortic valve replacement (TAVR) remains undetermined.


This study sought to compare clinical outcomes with transfemoral access (TFA), transthoracic access (TTA), and nonthoracic transalternative access (TAA) in TAVR patients with severe PAD.


Patients with PAD and hostile femoral access (TFA impossible, or possible only after percutaneous treatment) undergoing TAVR at 28 international centers were included in this registry. The primary endpoint was the propensity-adjusted risk of 30-day major adverse events (MAE) defined as the composite of all-cause mortality, stroke/transient ischemic attack (TIA), or main access site-related Valve Academic Research Consortium 3 major vascular complications. Outcomes were also stratified according to the severity of PAD using a novel risk score (Hostile score).


Among the 1,707 patients included in the registry, 518 (30.3%) underwent TAVR with TFA after percutaneous treatment, 642 (37.6%) with TTA, and 547 (32.0%) with TAA (mostly transaxillary). Compared with TTA, both TFA (adjusted HR: 0.58; 95% CI: 0.45-0.75) and TAA (adjusted HR: 0.60; 95% CI: 0.47-0.78) were associated with lower 30-day rates of MAE, driven by fewer access site-related complications. Composite risks at 1 year were also lower with TFA and TAA compared with TTA. TFA compared with TAA was associated with lower 1-year risk of stroke/TIA (adjusted HR: 0.49; 95% CI: 0.24-0.98), a finding confined to patients with low Hostile scores (Pinteraction = 0.049).


Among patients with PAD undergoing TAVR, both TFA and TAA were associated with lower 30-day and 1-year rates of MAE compared with TTA, but 1-year stroke/TIA rates were higher with TAA compared with TFA.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Tomii, Daijiro, Pilgrim, Thomas


600 Technology > 610 Medicine & health








Pubmed Import

Date Deposited:

03 Mar 2023 17:18

Last Modified:

23 Mar 2023 10:10

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Uncontrolled Keywords:

alternative access critical patient femoral access transcatheter aortic valve replacement




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