868 “Post-Close” Technique for Large Calibre Vascular Access

Abstract

The modified “Preclosure” technique for immediate vascular access site closure described by Kahlert et al is well established and remains the mainstay for management of large calibre arterial access site. However, it involves the predeployment of three suture-based closure devices (most commonly the Perclose device) immediately after establishing access prior to dilatation for sheath insertion. When large calibre percutaneous femoral artery access is required in a time critical circumstance, it would be ideal to minimise time spent securing arterial access. We describe a case where percutaneous aortic valve replacement via transapical approach had to be converted to transfemoral approach intraoperatively, necessitating swift establishment of arterial access allowing insertion of a 14 French sheath with a dynamic expansion mechanism. Our novel “post-close” technique was successful in achieving large calibre vascular access site closure with excellent haemostasis without pre-deployment of Perclose devices. Firstly, manual pressure is applied proximal to the arterial puncture site. The large caliber sheath is then removed with simultaneous manual compression at the site of arterial puncture. Two Perclose devices were then deployed in the conventional manner, with further manual compression over the vessel subsequently. There were no vascular complications. This “post-close” technique would be particularly useful in emergency settings such as for portable haemodynamic devices and newer mechanical support devices like Impella (ABIOMED) where the “Preclose” technique has also been shown to be useful. Further studies with a larger sample are required to evaluate its safety and efficacy.