A novel technique for postclosure of large‐bore sheaths using two Perclose devices

Abstract

Objectives This study aimed to assess the feasibility, efficacy, and safety of a novel percutaneous postprocedure closure technique for large arterial sheath removal with the use of two Perclose ProGlide (Abbott Vascular Devices, Redwood City, CA) devices. Background Postprocedural closing of large‐bore arteriotomies using the Perclose system can be difficult given the subsequent inability of the device to capture sufficient wall tissue. Methods Our study was a single‐center retrospective analysis of 22 consecutive patients who underwent large arteriotomy closure via the postclosure technique with a 12–16‐Fr sheath. Efficacy endpoints included successful deployment of the system and hemostasis. Safety endpoints included the incidence of major or minor vascular complications as defined by the Vascular Academic Research Consortium‐2 (VARC‐2) definitions at 30‐day follow‐up. Results The postclosure technique resulted in 100% technical success rate and no postprocedural bleeding or vascular complications. Conclusion Postclosure technique is a safe, highly effective, and feasible percutaneous method to achieve large‐bore arteriotomy hemostasis with low rates of major bleeding or vascular complications and favorable early outcome.

A Post-closure Technique Using a Single Perclose Device in the Removal of a Transfemoral Impella Catheter

“…For the removal of a transfemoral Impella, surgical hemostasis, manual compression, and percutaneous device closure have been reported useful [5][6][7][8] . Surgical removal carries the risk of bleeding, surgical-site infection, and lymphatic leakage 13) .…”

“…Although a positive outcome with pre-closure using Perclose has been reported 5) , the Perclose must be placed in an urgent situation, and there is concern about contamination occurring during support. Although post-closure of an Impella catheter using a dual Perclose has been reported 7,8) , the single Perclose technique has comparable efficacy to a dual technique for achieving hemostasis of TAVI 11,12) .…”

“…Several hemostatic options exist for the removal of an Impella device, such as surgical closure, manual compression, and percutaneous closure device [5][6][7][8] . The post-closure method using a single Perclose (Abbott Vascular, Santa Clara, CA, USA), which is the simplest and least invasive technique available, has not yet been evaluated.…”

Cutting balloon for femoral arterial and venus obstructions due to suture‐based closure devices: Case series

“…For large arterial and venous sheath access, it is possible to use more than one closure device. 12 The ProGlide is advanced over a guidewire within the arterial lumen, after which the "feet" are deployed within the lumen F I G U R E 1 A suture-blocked artery treated with cutting balloon-before (A), during (B), and after (C). [Color figure can be viewed at wileyonlinelibrary.com] to abut the artery wall and temporarily occlude the vessel.…”

“…These devices are an effective alternative to manual compression. For large arterial and venous sheath access, it is possible to use more than one closure device 12 . The ProGlide is advanced over a guidewire within the arterial lumen, after which the “feet” are deployed within the lumen to abut the artery wall and temporarily occlude the vessel.…”