Impact of diabetes on clinical outcomes of patients with hostile vascular access undergoing TAVI: insights from the HOSTILE registry

Abstract Background Diabetes mellitus (DM) is associated with peripheral artery disease (PAD) and may increase the risk of vascular complications (VC) in patients with hostile femoral access undergoing TAVI. Aims To evaluate the association between DM, VC and clinical outcomes in this population. Methods and results The HOSTILE registry is an international study including consecutive patients undergoing TAVI with hostile femoral access, defined as severe bilateral iliofemoral PAD requiring percutaneous transluminal angioplasty or alternative access. Outcomes of patients with and without diabetes were compared and stratified by access strategy. Inverse probability of treatment weighting (IPTW) was used to adjust for baseline differences. The primary endpoint was VC of any vascular access. Secondary endpoints included major and minor VC and 30-day and one-year clinical outcomes. Among 1707 patients, 559 (32.7%) had diabetes. Diabetic patients had a higher burden of comorbidities and more severe PAD, represented by higher Hostile scores. Despite this, rates of VC were similar between diabetic and non-diabetic patients (IPTW-adjusted odds ratio 0.86, 95% confidence interval 0.68–1.08, P = .184), consistently across access strategies. 30-day and one-year all-cause mortality and ischemic outcomes did not differ between groups. DM was associated with a lower incidence of any bleeding at one year, driven by minor bleeding events. Conclusion In patients with hostile femoral anatomy undergoing TAVI, diabetes was associated with more severe PAD but not with an increased risk of VC, mortality, or ischemic events. These findings support the feasibility and safety of contemporary TAVI strategies in diabetic patients with complex peripheral anatomy.

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Publication Details

Journal
European Heart Journal - Valvular and Structural Heart Disease
Published
2026-04-01
DOI
https://doi.org/10.1093/ehjvshd/xwag028
Primary Topic
Vascular Procedures and Complications
Type
article
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article

Impact of diabetes on clinical outcomes of patients with hostile vascular access undergoing TAVI: insights from the HOSTILE registry

Tiziana Claudia Aranzulla, Max M. Meertens, Thomas Pilgrim, Tullio Palmerini et al.
European Heart Journal - Valvular and Structural Heart Disease
Vascular Procedures and Complications
article

Impact of diabetes on clinical outcomes of patients with hostile vascular access undergoing TAVI: insights from the HOSTILE registry

Tiziana Claudia Aranzulla, Max M. Meertens, Thomas Pilgrim, Tullio Palmerini, Fausto Castriota, Ole De Backer, Alessandro Iadanza, Marco De Carlo, Antonio Giulio Bruno, Stefan Toggweiler, Francesco Meucci, A. Bartorelli, D Braun, M Barbanti, M Joner, I Porto, G Tarantini, N M Van Mieghem, L Testa, F Tartaglia, Mohamed Abdel-Wahab, Pablo Codner, Pier Pasquale Leone, Georg Nickenig, Ran Kornowski, Matteo Montorfano, Gregg W Stone, Francesco Burzotta, Sergio Berti, Francesco Saia, Tommaso Piva, Azeem Latib, Giulio Stefanini
article en

Abstract

Abstract Background Diabetes mellitus (DM) is associated with peripheral artery disease (PAD) and may increase the risk of vascular complications (VC) in patients with hostile femoral access undergoing TAVI. Aims To evaluate the association between DM, VC and clinical outcomes in this population. Methods and results The HOSTILE registry is an international study including consecutive patients undergoing TAVI with hostile femoral access, defined as severe bilateral iliofemoral PAD requiring percutaneous transluminal angioplasty or alternative access. Outcomes of patients with and without diabetes were compared and stratified by access strategy. Inverse probability of treatment weighting (IPTW) was used to adjust for baseline differences. The primary endpoint was VC of any vascular access. Secondary endpoints included major and minor VC and 30-day and one-year clinical outcomes. Among 1707 patients, 559 (32.7%) had diabetes. Diabetic patients had a higher burden of comorbidities and more severe PAD, represented by higher Hostile scores. Despite this, rates of VC were similar between diabetic and non-diabetic patients (IPTW-adjusted odds ratio 0.86, 95% confidence interval 0.68–1.08, P = .184), consistently across access strategies. 30-day and one-year all-cause mortality and ischemic outcomes did not differ between groups. DM was associated with a lower incidence of any bleeding at one year, driven by minor bleeding events. Conclusion In patients with hostile femoral anatomy undergoing TAVI, diabetes was associated with more severe PAD but not with an increased risk of VC, mortality, or ischemic events. These findings support the feasibility and safety of contemporary TAVI strategies in diabetic patients with complex peripheral anatomy.

European Heart Journal - Valvular and Structural Heart DiseaseVol. 2(2)
University of Pisa (IT), University of Bern (CH), Albert Einstein College of Medicine (US), Montefiore Medical Center (US), Humanitas University (IT), University of Padua (IT), Vita-Salute San Raffaele University (IT), University of Lucerne (CH), University of Milan (IT), Cardiovascular Institute of the South (US), University Hospital Bonn (DE), Rabin Medical Center (IL), University Hospital of Bern (CH), Erasmus MC (NL), Agostino Gemelli University Polyclinic (IT), Copenhagen University Hospital (DK), Ospedale "Santa Maria delle Croci" di Ravenna (IT), IRCCS Policlinico San Donato (IT), Mount Sinai Hospital (US), Istituto Clinico Sant'Ambrogio (IT), Azienda Ospedaliero Universitaria Ospedali Riuniti (IT), Azienda Ospedaliero-Universitaria Careggi (IT), Leipzig Heart Institute (DE), Azienda USL di Bologna (IT), German Centre for Cardiovascular Research (DE), A. O. Ordine Mauriziano di Torino (IT), Kerckhoff Klinik (DE), Azienda Ospedaliera Universitaria Senese (IT), Ospedale Policlinico San Martino (IT), Deutsches Herzzentrum München (DE), Istituti di Ricovero e Cura a Carattere Scientifico (IT), University Hospital Cologne (DE), Fondazione Toscana Gabriele Monasterio (IT), Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco" (IT), IRCCS Humanitas Research Hospital (IT), Ospedali Riuniti Umberto I (IT), Azienda Ospedaliera Universitaria Pisana (IT), Ludwig-Maximilians-Universität München (DE), Erasmus University Rotterdam (NL), University of Bologna (IT)
Good health and well-being
Openalex Percentile: Top 29%
Vascular Procedures and Complications
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