Pre‐close technique of percutaneous closure for delayed hemostasis of large‐bore femoral sheaths

Abstract

Advancement of coronary interventions and portable hemodynamic device requires placement of large bore sheaths. Access for large caliber sheaths, its placement, maintenance, and hemostasis is very challenging and one of the key ailments for successful procedures. Traditional hemostasis method is manual compression, which is unattractive due to its own limitations and subsequent complications. Single closure device for sheath size larger than 8 French (Fr) is not available. We performed retrospective analysis of large cohort of patients with 13, 14 Fr sheaths (Impella device [ABIOMED]) percutaneous closure with the use of two Perclose devices. Two perclose devices were placed in a "Preclose" fashion and hemostasis was obtained few days later once hemodynamic support was weaned off by deployment of perclose sutures.

Percutaneous Left Ventricular Assist Device in Cardiogenic Shock: A Five-Year Single Canadian Center Initial Experience

“… 31 , 32 An Impella arteriotomy preclosure technique has also been described. 33 In addition, these patients were critically ill with multiple metabolic derangements, including hepatic dysfunction, which can contribute to coagulopathy. Moreover, patients frequently had chest trauma from cardiopulmonary resuscitation, were exposed to multiple antithrombotic agents, and may develop acquired Von Willebrand syndrome due to high blood shear forces caused by Impella CP.…”

Single‐access during Impella hemodynamic support utilizing the Railway system

“…We then proceeded to perform preclosure of the left common femoral artery. This technique has been previously described 3 . After successful preclosure and placement of the 14 F sheath, the Impella CP device (Abiomed) was successfully placed in the LV per the instructions for use.…”

“…The 14 F sheath was removed, peeled away, and the repositioning sheath was placed without oozing. The perclose sutures were secured in place similar to the technique described by Lata et al 3 The patient did well overnight, including tolerating postprocedure hemodialysis. He underwent successful Impella (Abiomed) removal the following day in the Cath Lab utilizing the previously placed preclose sutures.…”

Complications and Avoidance in Neurointerventional Surgery

“…1). Puncture site closure devices, including collagen plugs, percutaneous devices, and external compression devices, have become popular recently to prevent access-related complications [16][17][18] though concrete evidence regarding their benefits in reducing complications is still lacking.…”