Author + information
- S1936879815020233-991616b025233c89d522124e8025f595Michael Amponsah,
- S1936879815020233-18bbea760d1ae42a4b685b91f6c0cf95Rajiv Tayal,
- S1936879815020233-498da79748b05f50fe8f199f662b4906Sankalp Pathak,
- S1936879815020233-6eb643447d24750ed57bd703beef8ffcIsheeka Edwards,
- S1936879815020233-0251205f79aaa5a2d13cfde10c047fa6Zain Khakwani,
- S1936879815020233-dd4ae5e5a9406b374271d21af7050825Humayun Iftikhar,
- S1936879815020233-b86a51107aab8c198771d95addb49ae6Marc Cohen and
- S1936879815020233-e87458c5dc56ce1b90902cffc4832c60Najam Wasty
The “pre-close” technique employing two Perclose (P) (Abott Vascular, CA) is well established for large-bore arteriotomy (LBA) closure. We theorized that using 1 P and 1 Mynx (M) (Accessclosure, CA) or Angioseal (A)(St. Jude Medical, MN) vascular closure device (VCD) in a hybrid closure (HC) technique would be a safe and effective alternative for LBA closure up to 14Fr.
43 patients (pts) underwent either high-risk PCI (hrPCI) with Impella (I)(Abiomed, MA) support or TAVR with the Sapien S3 (Edwards, CA) valve. 38 hrPCI pts and 3 TAVR pts had femoral arteriotomy (AR). 2 hrPCI pts underwent axillary artery AR for I insertion due to lower extremity PAD. Prior to I insertion via the common femoral or axillary artery, 1 P device was pre-deployed. At the end of hrPCI, I was removed and a 0.035 wire was inserted through the I sheath (IS). The IS was then withdrawn over the wire and the partially deployed P was fully deployed as the IS was being withdrawn. A 6 Fr sheath was then quickly advanced over this 0.035 wire into the artery achieving hemostasis and effectively reducing the LBA to a 6Fr. An 8Fr sheath was used in cases where the 6Fr did not achieve hemostasis. The 6F or 8Fr AR was then closed with the appropriate size M or A VCD. Non-occlusive manual pressure was held for 5 minutes if M VCD was deployed. The technique was identical in the 3 TAVR cases in which the S3 delivery system was used. Patients were followed the next day and then at 1 month.
HC achieved hemostasis in 41/43 cases. In the case of M balloon rupture, hemostasis was achieved after heparin reversal and application of prolonged manual compression. In the case of P failure, the cross over balloon technique followed by manual compression was successfully used. Patients were free of complications at day 1 and day 30.
HC with 1P and 1M or 1A VCD is safe and effective in LBA closure up to 14Fr size.