IP077. Two-Device Closure Method for Large-Diameter Arteriotomies in Percutaneous Endovascular Aortic Repair

Abstract

Percutaneous endovascular aortic repairs are associated with access site complications. As endovascular devices become more sophisticated and frequently require large-bore arteriotomies, several devices and techniques have been described to aid in the percutaneous closure of arteriotomies, including collagen plug devices (Angio-Seal; Terumo Interventional Systems, Somerset, NJ) and percutaneous suture-mediated closure devices (Perclose; Abbott Vascular, Santa Clara, Calif). Two-device preclose technique using two Perclose devices has been well established. Combined Perclose and Angio-Seal technique has been described for arteriotomies up to 14F because of instances of only a single Perclose device successfully predeployed during the preclose technique. We sought to determine whether a hybrid Perclose and Angio-Seal closure technique would safely and effectively establish hemostasis in large-bore arteriotomies up to 20F. Before sheath insertion, one Perclose device was predeployed. At the end of percutaneous endovascular aortic repair, device sheath and introducer were withdrawn over a 0.035-inch wire, and partially deployed Perclose was fully deployed. The sheath and introducer were fully withdrawn, and the arteriotomy was closed with a 6F Angio-Seal vascular closure device. Patients were observed at day 1 and day 30 and at least 1 year after intervention. A composite end point of complications was defined as an access site-related bleed or hematoma or retroperitoneal hematoma that required blood transfusion, pseudoaneurysm, arteriovenous fistula, or dissection. The combined technique was initially successful in 44 of 46 arteriotomies (95.6%) in 24 of 26 patients (92.3%) with no conversions to cutdown. Sheath sizes ranged from 10F to 20F outer diameter (OD), with an average of 15.85F OD. In the two instances in which satisfactory hemostasis using this method was not initially achieved, Perclose failure and Angio-Seal failure each accounted for a singled episode and required manual compression. Both instances occurred in a 20F arteriotomy. The only late complication of this method was a subcentimeter pseudoaneurysm in the arteriotomy where the perclose device did not deploy. There were no other early or late complications in this series. Large-bore arteriotomies can be safely and effectively closed using a hybrid percutaneous closure technique for sheaths up to 19F OD. Further investigation is needed to assess the value of this closure in 20F OD sheaths and above.