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Figure 2 Percutaneous Access and Closure

(Left) Needle puncture of the common femoral artery was followed by placement of percutaneous arterial sutures before insertion of a large 24-F internal diameter (9 mm external diameter) sheath. After valve implantation, a knot pusher is used to advance the sutures knots through the subcutaneous tissues to artery. (Right) Hemostasis was achieved immediately after sheath removal without the need for surgical exposure of the artery. Future reduction in sheath diameter is anticipated to make percutaneous closure more routine.