Percutaneous closure of catheter enterotomy: Feasibility determination in vivo

Abstract

Aim: To determine whether a catheter enterotomy can be percutaneously sealed with a commercially available vascular closure implant. Material and methods: The study was performed using a porcine model of small intestinal obstruction. Preliminary experiments were performed to allow an informed choice between two of the most promising commercially available alternatives: A multipronged metal clip (StarClose®) and a resorbable anchored polymer plate (FemoSeal®). Thereafter closure of seven enterotomies was attempted with the most suitable implant. The deployment procedure was subjectively analyzed. The sealed enterotomies were visually evaluated and hydrostatically tested. Results: StarClose was rejected for formal assessment because it was both difficult to deploy and could not ensure a watertight seal. The conventional method for deploying FemoSeal was found to be inappropriate for percutaneously closing enterotomies. However an improvised accessory allowed all seven enterotomies to be successfully sealed with the implant using a modified procedure that involved only one additional step. After closure, six of the seven enterotomies tolerated intraluminal pressure up to 65 mm Hg. Conclusion:FemoSeal has the potential to serve as an implant for percutaneous closure of catheter enterotomies if the deployment tool can be appropriately modified.