Background Small femoral arteries have been associated with a higher risk of vascular complications in transfemoral transcatheter aortic valve replacement (TAVR). We investigated the feasibility and safety of TAVR in patients with small femoral arteries. Methods In this observational study, we included 82 patients who underwent transfemoral TAVR with the ACURATE neo system using the expandable 14F iSleeve sheath between 2018 and 2019 at Karolinska University Hospital, Sweden. Of these, 41 patients had a minimal femoral artery diameter of ≥5.5 mm (mean 6.5, range 5.5–9.2), and 41 patients had a minimal femoral artery diameter <5.5 mm (mean 4.9, range 3.9–5.4). Results There was no significant difference in major vascular and bleeding complications between the small femoral artery group (7%) and the normal femoral artery group (2%) (p=0.62). The total of major and minor vascular complications did not differ significantly according to femoral artery size (17% vs 5%) (p=0.16). The iSleeve sheath was not correlated with any of the complications. The use of the iSleeve sheath was unsuccessful in four patients (5%), of which one patient had a small femoral artery diameter. Conclusion Transfemoral TAVR with the ACURATE neo system using the iSleeve sheath is a promising method for patients with small femoral arteries even though we found a trend towards higher rates of complications in these patients. The use of expandable sheaths may expand the spectrum of patients that can be treated with transfemoral TAVR, and thus may improve the prognosis in patients with severe aortic valve stenosis. All data relevant to the study are included in the article or uploaded as supplementary information.

中文翻译：

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在小股动脉中使用 iSleeve 可膨胀鞘进行经导管主动脉瓣置换术

背景 在经股动脉经导管主动脉瓣置换术 (TAVR) 中，小股动脉与血管并发症的较高风险相关。我们研究了 TAVR 在小股动脉患者中的可行性和安全性。方法 在这项观察性研究中，我们纳入了 2018 年至 2019 年在瑞典卡罗林斯卡大学医院使用可扩张 14F iSleeve 鞘管使用 ACURATE neo 系统接受经股动脉 TAVR 的 82 名患者。其中，41 名患者的最小股动脉直径≥5.5 毫米（平均 6.5，范围 5.5-9.2），41 名患者的最小股动脉直径 <5.5 毫米（平均 4.9，范围 3.9-5.4）。结果小股动脉组（7%）与正常股动脉组（2%）在主要血管和出血并发症方面无显着差异（p=0.62）。根据股动脉大小，主要和次要血管并发症的总数没有显着差异（17% vs 5%）（p=0.16）。iSleeve 护套与任何并发症无关。4 名患者 (5%) 使用 iSleeve 鞘管不成功，其中 1 名患者的股动脉直径较小。结论 使用 iSleeve 鞘的 ACURATE neo 系统经股骨 TAVR 是一种有前途的方法，尽管我们发现这些患者有更高的并发症发生率的趋势。可扩张鞘管的使用可以扩大经股动脉 TAVR 治疗的患者范围，从而改善严重主动脉瓣狭窄患者的预后。与研究相关的所有数据都包含在文章中或作为补充信息上传。